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Biomedical subjects

J M Augé

Publications and source records attributed to J M Augé.

At least 19 recordsLinked to original sources
PubMed1992

[An obstruction of a valve prosthesis implanted in the tricuspid position].

Dysfunction of a prosthesis implanted in tricuspid position is a severe complication that may develop with minimal symptoms. A patient who presented clinical manifestations of heart failure for two weeks due to obstruction of a mechanical prosthesis in tricuspid position is described. Fibrinolytic treatment was given unsuccessfully, therefore prosthetic replacement was performed. In the removed prosthesis, a fibrotic pannus which developed in the strut and disc was seen. We review the clinical manifestations, the diagnosis and treatment of the dysfunction of a prosthesis implanted in tricuspid position.

Aortic Valve↗
PubMed1991

[Coronary fistula to the right ventricle in heart transplant patients as a complication of repeated endomyocardial biopsies].

Ninety-six coronary angiographies of 30 orthotopic heart transplant recipients were studied. Eleven coronary artery fistulas to right ventricle were seen in 7 (23.3%) patients; five involved the left anterior descending artery, four the right coronary artery, and two the circumflex artery. All the coronary arterial fistulas appeared within the first year after transplantation, when endomyocardial biopsies were more frequent. In the review of the histologic samples, we found coronary arterioles greater than 0.15 mm of diameter in 3 of 7 patients with coronary arterial fistula; on the contrary, those were not found in any of the 69 histologic samples of 23 heart transplant patients without coronary fistula (p less than 0.001). Neither clinic nor hemodynamic abnormalities were seen in any patient during the follow-up. The coronary fistula had a benign course, with a tendency to decrease in size and to close spontaneously.

Biopsy↗
PubMed1991

Left ventricular dynamics and plasma catecholamines during isometric exercise in patients following cardiac transplantation.

Haemodynamics and plasma catecholamine responses to isometric exercise were evaluated invasively in 11 orthotopic heart transplant recipients and seven control subjects. Differences in haemodynamic responses between the two groups were already apparent after one min of handgrip at 30% of maximal voluntary contraction, and very pronounced at the end of the fourth minute. At this point transplanted patients showed smaller increments in heart rate (4.8 +/- 3.2 vs 20.4 +/- 14.1 beats.min-1, P less than 0.001), mean arterial pressure (13.7 +/- 7.2 vs 31.5 +/- 12.2 mmHg, P less than 0.001) and cardiac index (0.51 +/- 0.22 vs 1.02 +/- 0.53 L.min-1.m-2, P less than 0.01), whereas left ventricular end-diastolic pressure increased to a greater extent (8.8 +/- 4.9 vs 2.2 +/- 1.8 mmHg, P less than 0.01). Stroke volume index increased similarly (3.8 +/- 1.8 vs 2.0 +/- 3.5 ml beat-1.m-2, NS) and systemic vascular resistance remained unchanged in both groups. The slopes of the left ventricular function curves (ratio of change in left ventricular work to change in left ventricular end-diastolic pressure) indicated depressed left ventricular function in the transplanted patients. The two groups showed similar increments in mixed venous plasma norepinephrine and epinephrine indicating normal sympathoadrenal activation in the transplanted patients. In conclusion, transplanted hearts respond to handgrip with attenuated increases in heart rate, cardiac output and arterial pressure and by increasing left ventricular filling pressure, suggesting a poor contractile reserve probably due to denervation. Circulating catecholamines, especially epinephrine, probably contribute to the cardiac responses to isometric exercise.

Adult↗
PubMed1991

[Coronary disease after the radiotherapy of the mediastinum in Hodgkin's disease].

A 32-year-old man with Hodgkin's disease presented an acute myocardial infarction following mediastinal irradiation. A complete occlusion at the level of the proximal segment of the right coronary artery and a moderate stenosis of the left circumflex coronary artery was demonstrated by selective coronary angiography. An inferior hypokinesia was seen by the ventricular angiography. We discuss the possible role of the mediastinal irradiation in the induction of coronary heart disease as well as the importance of an early diagnosis.

Adult↗
PubMed1990

Indium-111-monoclonal antimyosin antibody studies after the first year of heart transplantation. Identification of risk groups for developing rejection during long-term follow-up and clinical implications.

The long-term clinical course and results of biopsies in 21 patients studied with monoclonal antimyosin antibodies more than 12 months after heart transplantation according to the presence and degree of antimyosin-antibody uptake is described. Eighteen men and three women aged 20-52 years (39 +/- 9 years) were studied with antimyosin antibodies 12-40 months (mean, 22 +/- 9 months) after heart transplantation, and followed for a mean of 18 months (10-28 months). The number of biopsies performed during follow-up was 102. Results showed normal antimyosin-antibody studies in nine patients and abnormal studies in 12 patients. Myocyte damage was identified in 18 of the 102 biopsies (17.6%), one in the normal antimyosin-antibody group of patients and 17 in those patients with myocardial antimyosin-antibody uptake. Patients who developed rejection comprised 11% and 67% of each respective group; the mean number of rejection episodes per patient was 0.11 +/- 0.33 and 1.41 +/- 1.41, respectively (p less than 0.01). A trend was noted by which higher heart-to-lung ratios were associated with greater probability of rejection. Conclusively, 1) antimyosin-antibody studies performed after more than 1 year after heart transplantation indicate the presence and level of rejection activity, 2) groups of patients at risk for developing rejection at biopsy during long-term follow-up may be detected by antimyosin-antibody study, and 3) surveillance for rejection and the degree of immunosuppression should be tailored to meet individual patient needs.

Adult↗
PubMed1990

[The single coronary artery. Presentation of a case].

A patient with a single coronary artery originating in the right coronary sinus is presented. The condition was diagnosed during aortic valve replacement surgery and later confirmed by coronary angiogram. The clinic significance in relation to the anomalous course of the coronary artery and the importance of correct diagnosis prior to cardiac surgery is discussed.

Aortic Valve Stenosis↗
PubMed1989

Five years of angiographic and clinical follow-up after successful percutaneous transluminal coronary angioplasty.

The first 67 consecutive patients (77 lesions) who underwent successful coronary angioplasty (PTCA) at our hospital were clinically followed with serial exercise testing over a 5-year (4 to 7) observation period. Two sequential angiographic controls were performed 6.9 +/- 4.6 (64 patients) and 49.5 +/- 21.6 (42 patients) months after PTCA. The 5-year risk of cardiac death was 8%, of myocardial infarction 2%, or coronary artery bypass grafting 16% and of repeat PTCA 8%. At 5 years, 67% of the patients remain asymptomatic. Restenosis greater than or equal to 70% diameter was observed within the first year after PTCA in 30% of the patients. Progression of coronary artery disease (CAD) was observed in 13 patients (20%). In the first angiographic control, CAD progression was 4% (3/77) in dilated and 3% (3/115) in non-dilated arteries (ns). In the second angiographic control, it was 7% (3/45) and 10% (8/81), respectively (ns). Thus good clinical and angiographic results are still observed after 5 years. Restenosis is an early, self-limited, time-restricted phenomenon that occurs in 30% of patients. Angioplasty does not appear to accelerate CAD progression.

Angina Pectoris↗
PubMed1989

Prevention of aortocoronary vein-graft attrition with low-dose aspirin and triflusal, both associated with dipyridamole: a randomized, double-blind, placebo-controlled trial.

A randomized, double-blind, placebo-controlled trial was performed in 209 patients to evaluate the efficacy of a low dose of aspirin plus dipyridamole or that of a new antiplatelet agent (triflusal) plus dipyridamole in the prevention of aortocoronary vein-graft occlusion. An angiographic control performed in 161 patients 9 days after surgery showed no significant differences between groups, but a new control on 138 of those patients 6 months later did show significant linear trends towards fewer distal anastomosis occlusions (P = 0.027) from the placebo (24%, 22/91) to the aspirin (16%, 17/106) and to the trifusal groups (12%, 10/86), and towards fewer new occlusions (P = 0.056) from 12% (9/78) to 10% (10/99) and to 2.6% (2/78), respectively, in the same groups. A multivariate logistic regression model, used to determine the effect of 33 variables on distal anastomosis occlusion at 6 months control, demonstrated that diameter of distal bed (P = 0.006), moderately to severely atherosclerotic distal bed (P = 0.003) and the interactions between poor distal bed and triflusal (P = 0.005) were independent predictors of occlusion. Thus, triflusal plus dipyridamole appeared superior to low-dose aspirin plus dipyridamole in the prevention of vein-graft occlusion, independently of coronary and vein-graft determinants of occlusion.

Adult↗
PubMed1988

Pulsed Doppler assessment of tricuspid regurgitation: usefulness of regurgitant signal patterns for estimation of severity.

A study on the value of pulsed Doppler in the detection and quantitative assessment of tricuspid regurgitation (TR) has been conducted on 33 consecutive adult patients with valvular heart disease. Only 1 patient had to be excluded owing to a technically inadequate Doppler examination. Data for comparison were obtained from a right heart catheterization performed within a twenty-four-hour interval from the Doppler study. Sensitivity and specificity in the detection of the lesion were 88% and 100%, respectively. A previously undescribed pulsed Doppler method for the estimation of the degree of TR was tested, based on the consideration of two distinctive patterns of the regurgitant Doppler signal: type I: a protosystolic regurgitant signal with progressively fading intensity along systole; and type II: a homogeneously intense pansystolic signal. Correlation between these patterns and the angiographic degrees of TR showed that milder lesions correspond to the type I Doppler pattern, whereas significant regurgitations present a type II pattern, this allowing a clinically useful method of assessment of TR.

Cardiac Catheterization↗
PubMed1988

Clinical and hemodynamic results of cardiac valve replacement with the Monostrut Björk-Shiley prosthesis.

Between May 1983 and April 1986, 318 patients underwent cardiac valve replacement with the Monostrut Björk-Shiley prosthesis. There were 136 aortic valve replacements, 128 mitral valve replacements, and 54 multiple replacements. A total of 373 valves were implanted. Associated procedures were done in 79 (25%) of the patients. Hospital (30-day) mortality rate was 5.6% (18 patients): 2.9% (n = 4) after aortic, 7.8% (n = 10) after mitrals and 7.4% (n = 4) after multiple valve replacement. Follow-up was obtained in all 300 operative survivors, for a total of 500 patient-years (mean 18 months). Actuarial survival rate, excluding operative deaths, at 4 years was 94.7% +/- 1.5% (mean +/- standard error of the mean). There were 16 thromboembolic episodes (3.2/100 patient-years). Freedom from all valve-related complications was 87% +/- 2.4% at 3 1/2 years. Neither valve thrombosis nor structural failure has been observed. Eighty percent of the patients are in New York Heart Association functional class I. Forty-two patients (26 with aortic and 16 with mitral valve replacement) underwent cardiac catheterization a mean of 6 1/2 months after the operation. In the aortic position, peak gradients were an average of 6.9 +/- 1.2 mm Hg. Mean systolic gradients were 12.4 +/- 6.3 mm Hg and did not increase with exercise. In the mitral position, end-diastolic gradients were an average of 2.1 +/- 2 mm Hg and mean gradients, 5.9 +/- 2 mm Hg. Discharge coefficient (estimated orifice area/geometric area) was 0.63 +/- 0.2 for the aortic and 0.53 +/- 0.2 for the mitral prostheses. Disc opening was maximal in most patients. These results indicate that the Monostrut prosthesis has a low rate of thromboembolic events, no structural failures or thrombotic obstructions and excellent hemodynamic performance, especially in the small aortic sizes (discharge coefficient for 19 and 21 mm valves, 0.77).

Adolescent↗