Fibrinolytic treatment of thrombosis of prosthetic heart valves.
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Adult↗
Biomedical subjects
L Ledain
Publications and source records attributed to L Ledain.
[Anti-arrhythmic effects of mexiletine].
Mexiletine was used in 12 patients. Serum drug levels and the antiarrhythmic effects were studied in a therapeutic protocol comprising an initial intravenous administration (3,5 mg/Kg over 10 mins, then 450 mg in 5 hours) followed by oral administration (200 mg eight hourly). The serum drug levels of Mexiletine were high (1,46 +/- 0,47 microgram/ml) as from the first hour in all patients, and remained constant during intravenous administration (average: 1,59 +/- 0,72 microgram/ml). On oral therapy the average mexiletine level was 1,18 +/- 0,21 microgram/ml with two lows (1,02 microgram/ml) six to eight hours after the ingestion of the 200 mg gelules. Ventricular extrasystoles completely regressed after the initial rapid intravenous injection in 7 out of the 12 patients (58,3 p. 100) and this efficacity was maintained throughout the trial. In two patients with low serum mexiletine levels at the end of oral therapy (less than 1 microgram/ml), ventricular extrasystoles were much less frequent during the intravenous phases but reappeared during oral therapy. The clinical, electrocardiographic and hemodynamic tolerance was good (withdrawn in only one patient). The dose should be adapted to the patient's weight and hemodynamic status. When ineffective, the serum mexiletine level can be estimated and when less than 1 microgram/ml, the dose may be increased, in particular by adjusting oral dosage to 200 mg six hourly.
Administration, Oral↗
[Left ventricular aneurysms. Prognostic study. Operative results].
Eighty three patients with symptomatic post-myocardial infarction left ventricular aneurysms (cardiac failure: 62 cases; angina; 41 cases; ventricular arrhythmias: 37 cases; systemic embolism: 8 cases) underwent surgery between 1975 and March 1981. Preoperative investigations comprised clinical examination, left heart catheterisation and ventriculography. End systolic and end diastolic volumes, ejection fraction velocity of circumferential fibre shortening, and the akinetic surface area were calculated firstly for the whole of the left ventricle and then for the contractile zones after hypothetical resection of the aneurysm. Selective coronary angiography was carried out in 75 patients. The results were as follows: 16 perioperative fatalities (19.2 p. 100): Group IA; 14 late deaths or not improvement after surgery (17 p. 100): Group IB; 53 patients had little or no symptoms after surgery (63 p. 100), Group II. The 5 year survival rats is 69.7 p. 100. Severe cardiac failure (Stages III or IV of the NYHA Classification) is associated with a poor prognosis (33 p. 100 mortality). The hemodynamic parameters of the whole ventricle (end diastolic volume, global ejection fraction) had little or no correlation with the outcome. The ejection fraction of the contractile zones was significantly lower in Groups IA and IB (0.39 +/- 0.08, and 0.41 +/- 0.05) than in Group II (0.51 +/- 0.05), p less than 0.001). When the ejection fraction of the contractile zone exceeded 0.45, good results were obtained in 90 p. 100 of cases. The velocity of circumferential fibre shortening was also a good prognostic index (0.63 +/- 0.18 in Group IA compared to 1.10 +/- 0.09 in Group II, p less than 0.001). On the other hand, the diastolic volume of the contractile zone was very variable in all three groups. Extensive coronary artery disease not treated surgically worsened the prognosis (50 p. 100 mortality in triple vessel disease.) Seven of the 8 patients operated during the acute phase of myocardial infarction (less than I month) died, but they all had very poor hemodynamic parameters.
Adult↗
[Hemodynamic effects of percutaneous trinitrin].
The haemodynamic effects of nitroglycerin (NG) ointment were studied in 13 patients, 6 with congestive cardiac failure. After two basal measurements 30 minutes apart, heart rate (HR), right atrial pressure (RAP), pulmonary artery diastolic pressure (PADP), mean systemic arterial pressure (MAP) and cardiac index (CI) were measured every fifteen minutes for one hour, and every hour for five hours. Two patients were given one capsule, and nine patients two capsules of 10 mg NG, applied on separate 15 cm2 skin patches and covered with plastic dressings. There was a slight fall of 1,9% in HR from the 45th minute to the 5th hour. A large increase in HR was only observed in one patient who had low basal filling pressures. A moderate decrease in MAP was recorded (4,6%, p less than 0,05) The greatest changes were observed in RAP which decreased (p less than 0,05) from the 30th to the 60th minute with a maximum at the 45th minute (17,4%) and in PADP which fell from the 15th minute to the 5th hour (p less than 0,005) with a maximum at the 120th minute (21,9%). Local tolerance was good. The systolic blood pressure did not fall below 90 mm Hg in any patient. A case by case analysis showed falls of RAP and PADP of over 20% in 10 and 9 patients respectively. The decrease in PADP was not proportional to the basal value but patients with the highest initial values had the least changes. A 20% fall in PADP was observed in only one of four patients with PADP of over 25 mm Hg at rest. A greater dose of NG might have had a greater effect in these patients. There was no significant change in CI, probably due to the stability of peripheral arterial resistances during the study. The value of this preparation of NG lies in its long duration of action. A fall in PADP of over 15% was observed up to the 150th minute, and persisted to a lesser degree up to the 5th hour. This makes it very suitable for the treatment of nocturnal angina as conventional antianginal delayed release nitrate derivatives usually have a shorter duration of action.
Adult↗
[Long-term treatment of severe cardiac insufficiency with captopril].
23 patients with a mean age of 62 +/- 7 years and suffering from a cardiomyopathy with severe chronic heart failure (16 patients in stage IV of the New York Association (NYHA) classification and 7 in stage III NYHA) received long term treatment with captopril (9 patients received 75 mg/day, 9 received 150 mg/day and 5 received 300 mg/day) with a follow-up of 12 +/- 9 months. Following the acute administration of captopril, there was an increase in the cardiac index (Cl) (2.76 +/- 0.56 vs 2.10 +/- 0.4 l . min-1 . m-2, p less than 0.001) between the 4th and 6th hour, a significant decrease in peripheral resistance (PR) (1416 +/- 304 vs 1094 +/- 406 dynes/s/cm-5, p less than 0.001), total pulmonary resistance (TPR) (537 +/- 228 vs 660 +/- 258 dynes/s/cm-5, p less than 0.01) and pulmonary diastolic pressure (PDP) (15.4 +/- 7.2 vs 18.6 +/- mm Hg, p less than 0.001). An early (3rd day) and reversible renal failure caused the treatment to be suspended in one patient. In the 22 other patients, a marked and lasting clinical improvement was obtained (18 patients with stage II NYHA and 4 with stage III NYHA). The beneficial haemodynamic effects persisted until the 4th month in 14 patients (Cl: 2.38 +/- 0.4 vs 2.10 +/- 0.4 l . min-1 . m-2, p less than 0.1; PR: 1828 +/- 314 vs 2054 +/- 406 dynes/s/cm-5, p less than 0.01; TPR: 526 +/- 284 vs 660 +/- 258 dynes/s/cm-5, p less than 0.01; PDP: 16.8 +/- 8.7 vs 18.6 +/- 8.6 mmHg, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗