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J M Perron

Publications and source records attributed to J M Perron.

18 recordsLinked to original sources
PubMed2004

["Optigo" hand-held echocardiography in post-surgery of coronary artery bypass graft].

INTRODUCTION: After all the advances in electronic miniaturization, first hand-held echocardiographs have finally appeared in echocardiographic laboratories. However, questions still remain about their usefulness in our everyday practice and also about their good diagnosis accuracy. Since some of them do not offer modes such as pulsed or continuous wave Doppler, nor M-mode, they cannot compete with conventional devices. However, they do offer advantages such as their long autonomy, the good quality of their image as well as the one obtained with colour-Doppler mode, in addition obviously to the fact that they can be carried around very easily. OBJECTIVES: To better define their possible uses, we assessed capabilities of one of them, the Optigo (Philips Ultrasound) to analyse patients who had undergone coronary artery bypass surgery. METHOD: Fifty patients have been included in this study few days after the surgery. Each of the patients had two echocardiographic examinations, one with a conventional device and one with the Optigo. Two separated and blinded observers for a subsequent and side-by-side criteria comparison performed the two echocardiograms. RESULTS: Hand-held echocardiography had a good diagnosis accuracy varying from 85% to 95% depending on the analysed criteria. It was more specifically good in the analysis of global or regional left heart function and of the right cavities as well as detecting the existence of pericardial effusion. CONCLUSION: Hand-held echocardiographic device demonstrated high accuracy in assessing patients with recent coronary bypass surgery especially regarding cardiac function and pericardial effusion diagnosis.

Coronary Artery Bypass↗
PubMed2003

[Cardiac manifestations of amyloidosis by deposits of transthyretin and apolipoprotein A1. Report of 3 families].

Amyloidosis is characterised by extracellular deposits of a heterogenous protein. Compared with secondary forms, hereditary amyloidosis due to genetic mutations is rare. The authors report the cardiac manifestations in a French family of 5 sisters and 1 brother, three of whom presented with amyloidosis with deposits of transthyretin and apolipoprotein A1 due to a new genetic mutation.

Adult↗
PubMed2003

[Contrast echocardiography: from experimental validation to practice].

After a long wait, contrast echocardiography is at last becoming a reality. The experimental validation step has been passed with success and the first clinical results bring confirmation. The second generation contrast agents which are arriving on the market, and the spread of enhancement techniques such as Real-Time mode allow perfect visualisation of microbubbles within the left ventricular cavity, but equally at the level of the myocardial crown, thus targeting two direct applications in echocardiography: the first, indisputably, concerns the improvement in the detection of the endocardium in all the situations where it is insufficient, and in particular during stress echography; the second, more ambitious, confronts the study of myocardial perfusion, with a yet to be defined place in clinical practice.

Contrast Media↗
PubMed2002

[Study of variations in preload on the new echocardiography parameters of diastolic function in health subjects].

The standard Doppler indices of transmitral filling are changed by variations in preload, relaxation and left ventricular compliance. Recent work in the literature suggests that the new parameters of diastolic function [mitral flux propagation speed in colour TM. (Vp) and tissue Doppler mitral ring velocities (Ea)] are independent of loading conditions. The objective of this work was to study the effect of modifications in the preload on Vp and Ea in normal subjects. Therefore, we have studied various Doppler echocardiographic measurements performed at rest, during a Trendelenberg manoeuvre at 60 degrees, and after sublingual administration of trinitrate in 25 healthy young (2 +/- 8 years) male volunteers. The end diastolic volume increased from 126 +/- 25 ml in the resting state to 145 +/- 24 ml during the Trendelenberg (p = 0.009) then decreased after trinitrate to 121 +/- 28 ml. The peak of the E wave increased from 88 +/- 12 cm/s in the resting state to 90 +/- 15 cm/s during the Trendelenberg and decreased to 70 +/- 11 cm/s after trinitrate (p < 0.0001). The peak Ea annular velocities of the septal and lateral walls were 22 +/- 4 cm/s and 15 +/- 1.6 cm/s in the resting state, without variation during the Trendelenberg (22 +/- 5 cm/s and 15 +/- 2 cm/s) but with a significant reduction after trinitrate to 19 +/- 5 cm/s and 13 +/- 2 cm/s (p = 0.02 and p = 0.002). In contrast, no significant variation was noted in Vp (60 +/- 14 cm/s in the resting state, 62 +/- 12 cm/s during the Trendelenberg and 59 +/- 14 cm/s after trinitrate). We conclude that Vp is not significantly affected by preload whereas Ea is not independent of the loading conditions.

Adult↗
PubMed2002

[Fibrinolysis and thrombosis of mechanical valvular prosthesis: risk stratification by transesophageal echocardiography].

The place of fibrinolysis in the treatment of mechanical valvular prostheses is still much discussed. The aim of this work is to define the role of transoesophageal echocardiography in risk stratification. This monocentric study draws on 49 cases of thrombolysis preceded by transoesophageal echocardiography (average age 62.1 years, 37 mitral, 11 aortic, 1 tricuspid, 1 mitro-tricuspid). There were 41 obstructive thromboses (OT) and 8 non-obstructive thromboses (NOT). Clinical events and the effectiveness of fibrinolysis were studied as a function of the obstructive or non-obstructive character of the thrombosis and the size of the thrombus < 10 mm (n = 33) or > or = 10 mm (n = 16). Complete success was observed in 34 patients (69.4%). Follow up revealed 2 early cerebral haemorrhages (4.1%) of which one was in the NOT group, and six systemic emboli (12.2%) of which one was in the NOT group. There was a relationship between the size of the thrombus and embolus at the limit of significance in favour of an increased risk of embolus for a voluminous thrombus. Furthermore, the mobility of the thrombi went in hand with an increased rate of systemic emboli (p < 0.01). The rate of failure of fibrinolysis and/or complications correlated with the size of thrombus (complete success in 88% of the < 10 mm thrombus group, versus 35% in the > or = 10 mm; p < 0.01). This work underlines the significance of trans-oesophageal echocardiography in the therapeutic choice for valvular prosthesis thrombosis and suggests that the existence of a voluminous thrombus especially if mobile is a contra-indication for fibrinolysis.

Adult↗
PubMed2001

[Fibrinolysis in myocardial infarction with EKG elevation. Optimization of myocardial reperfusion by treatment with antithrombotic agents].

In the case of acute coronary syndrome with prolonged ST elevation on ECG showing an acute coronary obstruction, the urgent institution of fibrinolysis is a widely validated treatment. Since the first placebo controlled studies with streptokinase until the development of bolus administration rt-PA varieties, fibrinolytic agents have lowered mortality. Associated anti-thrombotic drugs are multiplying in parallel. Their association is recognised as necessary in order to avoid early reocclusions which worsen the prognosis of infarction, the fibrinolysis triggering a harmful prothrombotic effect, notably due to the clot thrombin re-exposed during thrombolysis. Aspirin has an essential place formally demonstrated in ISIS 2. Non-fractionated heparin has more complex effects and its administration protocol in association with fibrinolysis has recently been reviewed with a reduction in dosage because prolonged clotting times during fibrinolysis have provoked a distinct increase in the risk of intracranial haemorrhage. The low molecular weight heparins seem to have become the adjuvant treatment of choice following publication of the ASSENT-3 trial. Pentasaccharide seems attractive. The place of hirudine and its derivatives in the acute phase of MI appear limited after the results of the HERO-2 trial, associating hirulog and streptokinase, with the earlier studies also having been disappointing. The GPIIbIIIa blockers in association with a half dose of fibrinolysis do not aggravate the intracerebral haemorrhagic risk before 75 years old and clearly reduce hospital morbidity in infarction, at the price however of an increase in transfusions.

Aspirin↗
PubMed2001

[Anticoagulation in mechanical valve prostheses. A difficult situation].

Although long-term anticoagulant therapy in patients with mechanical valve prostheses is well codified, a number of difficult situations persists because of the high thromboembolic risk. The protocols of anticoagulation suggested in these situations are controversial as there are no large scale prospective therapeutic trials. However, modern protocols take more and more into account the thromboembolic risk in each individual case. The authors review the most common situations: the early postoperative period for which no precise consensus exists in the literature; anticoagulation in extra-cardiac surgery, a common situation for which the protocols remain very debatable; anticoagulation in pregnancy, a special situation because of the risk of embryopathy with oral anticoagulant therapy and the risk of thromboembolism with heparin; anticoagulation in cases of thromboembolic complications; anticoagulation during infectious endocarditis; anticoagulation during serious haemorrhage.

Anticoagulants↗
PubMed1999

Can power motion imaging mode combined with contrast agent assess myocardial contraction and perfusion? In vitro and in vivo studies.

Power motion imaging (PMI) is a new Doppler imaging technology that can enhance contrast agent visualization. We hypothesized that PMI combined with Albunex injection (CPMI) could provide new insights into myocardial contractility and perfusion. In a first step, PMI signal was studied with an in vitro phantom. In a second step, PMI signal was studied in 10 rabbits at different workloads. In a third step, 10 rabbits were studied before and after ischemia produced by coronary ligation and finally during reperfusion. During the latter protocol, epicardial echocardiography analyzed by PMI and fundamental mode was performed before and after Albunex injection. PMI signal was well correlated with phantom velocity. PMI signal and myocardial wall thickening were well correlated, particularly in the septal area. On the coronary occlusion model, ischemia was associated with a significant decrease in PMI and CPMI signals, whereas reperfusion was associated with a significant decrease in PMI signals only, indicating stunning. We conclude that PMI combined with CPMI is a powerful tool to assess myocardial contractility and perfusion.

Albumins↗
PubMed1987

[Long stay or short stay in a protected environment?].

The authors analysed the population of a surveyed center that has been functioning for the last 20 years in Lausanne. They noticed, after having taken into account the different variables, that this population corresponds with what one can find in the literature concerning other surveyed centers. While comparing the samples of long-term with short-term patients in the surveyed center, the authors noticed that the long-term group was composed initially by younger boarders, all single and professionally less qualified than the short-term patients. The interval between the first hospitalisation and the admission to the center was much shorter. The prognosis of the long-term boarders was already initially worse. The period of the stay in the center is beyond the good or bad functioning of the center. According to this data, a limitation of the period of the stay in the center is not justified.

Adolescent↗
PubMed1980

[Interest of prolonged peridural anaesthesia in the treatment of thoracic injuries (author's transl)].

Prolonged peridural analgesia relieves the pain and thanks to immediate return of ventilatory function avoids most complications of poor prognosis in mobile sternum. After a historical and pharmacological survey, the authors describe a standard technic, the course and the necessary supervision. The study of 29 cases of mobile sternum of variable gravity, treated in this way, permitted the authors to determine the indications and contra-indications and the role of associated treatments: physiotherapy, surgical fixation, respiratory assistance. The rare failures may benefit from another therapeutic method.

Adult↗