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Biomedical subjects

M Ben Ismail

Publications and source records attributed to M Ben Ismail.

At least 37 records · Page 2Linked to original sources
PubMed1986

Cardiac valve prostheses, anticoagulation, and pregnancy.

The course of 76 pregnancies is reported in 51 women who became pregnant after replacement of one or more heart valves. Age at conception ranged from 17 to 39 years (mean 25). There have been 71 deliveries and five women are still pregnant at the time of writing. In the 71 pregnancies, oral anticoagulants were given during 53, heparin during five, and no anticoagulants during 13. Fetal complications consisted of 12 spontaneous abortions (eight in pregnancies in which oral anticoagulants were given, three in which heparin was given, and one in which no anticoagulants were given), of 12 premature deliveries with seven stillbirths (three on oral anticoagulants and four without anticoagulants), and there were three neonatal deaths (in all all three instances oral anticoagulants had been given during pregnancy). The maternal complications were as follows. Two women with mitral valve prostheses on heparin had thromboembolic episodes. Four women on oral anticoagulants died and 11 developed haemorrhage or systemic embolism. Two of the deaths were caused by bacterial endocarditis, one was the result of obstruction of a mitral valve prosthesis, and one was due to haemorrhage. One patient developed pulmonary oedema during delivery which rapidly resolved. Seven patients had uterine bleeding after delivery (three of them were on heparin and one was on an antiplatelet agent).

Abortion, Spontaneous↗
PubMed1986

[Infectious endocarditis surgically-treated in the active phase. Apropos of 46 cases].

The clinical and microbiological characteristics, the surgical indications and procedures, the evolution and the principal prognostic factors were reviewed in 46 cases of infectious endocarditis operated in the active phase. Using this date, the authors try to determine the optimal time for surgery during the acute active phase of infectious endocarditis. The study population comprised 28 men and 18 women aged 7 to 64 years (average age: 30). The patients were selected on strict criteria: positive blood cultures during the 48 hours prior to surgery (29 cases), positive valve or valve prosthesis culture (15 cases), the presence of an active cardiac abscess at surgery (7 cases), the presence of a large number of bacteria on histological examination of the valve (17 cases). The patients were divided into two groups: those with endocarditis of native valves (27 cases) and those with endocarditis on prosthetic valves (19 cases). The preoperative clinical features included all the classical signs of IE but congestive cardiac failure was particularly prevalent (62% of cases). Microbiologically, most cases of native valve endocarditis (67%) were due to sensitive organisms (streptococci) whilst the more virulent organisms (staphylococci, gram-negative bacteria and fungi) were observed in prosthetic valve endocarditis (64% of cases). The commonest surgical indication was haemodynamic deterioration (30 cases). The indications were mixed in 15 cases but only one case was operated for uncontrolled infection alone in this series. The surgical procedure was technically complex in 6 cases. Operative mortality was high (18 cases, 39%). The main cause of death was low cardiac output (13 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1986

[Early and late hospital mortality in myocardial infarction. Causes and prognostic factors. Apropos of 140 cases].

The purpose of this work is to study the causes of early and late in-hospital mortality of myocardial infarction, to define elements of prognosis and to attempt to prevent the fatal outcome of the coronary disease. This study concerns 107 men and 33 women, between the ages of 30 and 83 years (mean age 62.8 years). The total mortality is 12% (early: 6.5%, late: 5.5%. 66% of the patients are over 60 and 45% present 3 or more coronary risks factors. The clinical picture is characterized by frequent initial complications (84% of the cases), dominated by hemodynamic failure. The infarction is most of the time located anteriorly (56.6% of the cases). Primary cardiogenic shock represents the main cause of early mortality (55.3%). A recurrent infarction represents 75% of the causes of late deaths. Tri-vessels involvement and alteration of the ventricular function are noted in 9 out of 14 coronary arteriograms. Prognosis factors are proposed to differentiate high risk patients requiring an early coronary arteriogram in view of a specific medical and/or surgical treatment. The best signs of a poor prognosis are: tri-vessels involvement and alteration of the ventricular function.

Adult↗
PubMed1985

[Thromboembolic accidents in patients with mechanical prostheses and heterografts].

759 patients with a prosthetic valve replacement (335 mitral prostheses, 184 aortic prostheses and 240 double or triple valve replacements) were regularly followed-up for a total duration of 3 715 patient years. The mean age of these patients was 30 years. 681 (90%) of these patients were treated by long term anticoagulants, which were effective in only 320 patients. 78 patients did not receive anticoagulant treatment. 97 patients presented a total of 129 thrombo-embolic episodes (TEE), i.e. a frequency of 12.7 p. cent or 3.4 embolisms per 100 patients-year. The rate of TEE was influenced by the site of the prosthesis and by the presence or absence of complete arrhythmia due to atrial fibrillation, but it was not influenced by the quality of the anticoagulant treatment. In the patients with a heterograft, the rate of TEE varied according to the site of the prosthesis. In the aortic position, the rate of TEE in our series of prostheses was essentially similar to that reported in series of heterografts by Davila, Oyer and lonescu. This rate is generally higher for the mechanical prostheses in the mitral position and in the case of double valve replacement. The aim of this study was to deduce the current operative indications in relation to the choice of the type of valve replacement.

Adolescent↗
PubMed1984

[Long-term results of heterografts in the mitral position].

The long term results in 43 patients who underwent mitral valve replacement with a bioprosthesis are reported. The average age of the patient was 25, and nearly half of them were under fifteen. The underlying valvular disease was rheumatic in the great majority. Small bioprostheses were used in 40 p. 100 of cases. Hospital mortality was nil. Two patients developed atrioventricular block and needed permanent pacing; this was the principal complication observed in this study. After 34 months, 17 serious complications were recorded including two episodes of thromboembolism. The main problem arose from restenosis of the bioprosthesis, either because of its small size (3 cases) or because of degeneration (6 cases), all in children (33 p. 100 of our paediatric cases). The actuarial survival rate without degeneration shows only 48,2 p. 100 of patients to be without this problem at 5 years. Late mortality reached 29 p. 100 and the five year survival rate showed only 57 p. 100 of patients to be still alive, and only 35 p. 100 with their bioprosthesis. The haemodynamic profile of these prostheses with regards to transvalvular pressure gradient and mitral surface area, was very good for the large size valves, in contrast to the small size. In the absence of degeneration, the gradient was found to be stable. This study has shown that small bioprosthetic valves should be avoided in mitral valve replacement because of the risk of stenosis. Despite the low incidence of thromboembolism, they should not be used in children because of the high incidence of degeneration in paediatric patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

[Fate of Starr-Edwards prostheses in the mitral position. Prognostic factors. Apropos of 309 cases].

The authors report the long-term results of 309 patients undergoing isolated mitral valve replacement with a 6120 Starr Edwards mitral valve prosthesis in the great majority of cases, mainly for rheumatic mitral valve disease, with predominant mitral regurgitation. The average age was 26 +/- 14 years with 25% of children. The operative mortality was 9% and late mortality after a mean follow-up period of 4 years was 13,5% mainly due to thromboembolic complications and to myocardial dysfunction. The long-term results with an average 45 month follow-up showed a 10 year survival rate of 70,6% with an excellent clinical result in 71% of cases and an acceptable result in 10%; 20% of patients were considered poor long-term results because of myocardial dysfunction and thromboembolic complications. Endocarditis and perivalvular leaks were rarely observed (9 cases). A study of preoperative parameters which could influence long-term results showed that the quality of long-term survival was significantly correlated to age, the duration of cardiac disease before surgery, cardiomegaly and the presence of preoperative cardiac failure and tricuspid regurgitation. The incidence of thromboembolism was 4,7% patient years and the frequency of these complications was not related to the quality of anti-vitamin-K therapy. Patients under effective anticoagulant therapy had the highest incidence of haemorrhage (10%). This study confirms that the Starr Edwards 6120 prosthesis is a satisfactory choice for mitral valve replacement considering its durability (no cases of abnormal wear) and the 70% ten year survival rate. The problem of myocardial dysfunction could be resolved by earlier surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

[Reoperations on heart valve prostheses. Apropos of 58 cases].

In the period from 1968 to November 1980, 1 023 patients underwent surgery for single or multiple valve replacement. Fifty three patients (6,6% of the follow-up population) had to be reoperated, including 5 patients who had to be reoperated twice, giving a total of 58 reoperations. The average interval before reoperation was 30 months. The incidence was similar in monovalvular (7,5 p. 100 mitral valves, 5 p. 100 aortic valves) and polyvalvular (7 p. 100) cases. On the other hand, the incidence of reoperation of tricuspid prostheses (17 p. 100) was significantly superior to that of mitral valve (5,3 p. 100) or aortic valve (3,8 p. 100) prostheses. In 91 p. 100 of cases, the indication for reoperation was prosthetic valve dysfunction related to endocarditis in over a third of cases (21). In 32 cases, reoperation was required in the absence of any infectious process: 13 spontaneous perivalvular leaks, 10 thromboses, and 9 stenosing prostheses. There were no reoperations for wear of the prosthetic material. Only 9 p. 100 of patients were reoperated for uncorrected valvular disease. The prognosis of these reoperations was poor; hospital mortality being 42,5 p. 100. This high mortality rate is explained by the frequency of reoperation for infective endocarditis (36 p. 100) in our series, the mortality of which was 73,6 p. 100 and even higher when reoperation was an emergency for infectious or hemodynamic reasons. There was also a high mortality rate with reoperation for thrombosis (30 p. 100) because of the severe myocardial dysfunction in thrombosis of tricuspid prostheses and the emergency situation associated with mitral prosthetic valve thrombosis. Excluding these two complications, the average mortality was 21 p. 100. Although the surgical indications are relatively easy for thrombosis, perivalvular leak and stenosing prostheses, they are particularly difficult in infectious endocarditis especially with regards to the timing of reoperation. We believe that, ideally, reoperation should be delayed as long as possible to allow the antibiotic therapy the maximum time to take effect. Surgery can then be performed after controlling the infection and before the installation of severe hemodynamic distress.

Adolescent↗
PubMed1983

[Mitral valve prosthesis without anticoagulant treatment. Apropos of 46 cases].

Out of a total of 90 patients with valvular prosthesis not treated with anti-coagulants, 46 only had a prosthesis in the mitral position. These patients were treated in Professor Ben Ismail's department for an average of 58 months (extreme limits 26 and 116 months). The average age of these patients at the time of the operation was 13.6 years. It is important to note that these patients greatly improved as attested to by the evolution of the functional symptoms, cardiac volume, capillary and pulmonary arterial pressure. 7 patients had a thromboembolism (15.5 per cent or 3 embolisms per 100 patient-years). Three cases were minor or rapidly regressed and out of four major cases, one died. This complication is much more frequent in patients treated with anti-coagulants as is the risk of haemorrhage which is sometimes serious or even mortal. In view of these results, it seems legitimate, in these young patients, especially when they are in sino-astrial rhythm, have a good clinical history and are haemodynamic to forego anti-coagulant treatment which may be dangerous in these undisciplined patients under irregular and unusual treatment.

Adolescent↗
PubMed1983

[Thromboembolic and hemorrhagic complications in valve prosthesis patients].

567 patients with valve prostheses who received anticoagulant therapy were followed up by Professor Ben-Ismail's department at the Ernest-Conseil Hospital, over a period of 2 to 160 months (mean: 53 months). 220 of them had a mitral prosthesis, 183 had an aortic prosthesis and 161 had a double (153) or triple (8) valvular replacement. 66 patients (11.6%) presented a total of 85 thrombo-embolic episodes, i.e. a global incidence of 4.6 emboli per 100 patient-years. Amongst the thrombo-embolic incidents, there were 26 cases of valvular thrombosis, 47 cases of cerebral vascular accident and 11 cases of peripheral vascular emboli. The course was fatal in 18 cases. These accidents mostly occurred in the cases with mitral or polyvalvular replacements. More than one half of these patients were pursuing a regular and effective treatment. 55 patients presented a total of 60 serious haemorrhagic accidents, of which 10 died. This study reveals that the incidence of thrombo-embolic accidents is much higher in patients with mitral or tricuspid valve replacements and when the anticoagulant treatment is irregular or capricious. However, an apparently well managed anticoagulant treatment does not prevent the development of thrombo-embolic accidents and carries a significant risk of haemorrhage.

Adult↗
PubMed1981

[Valve replacement in children: results and long-term follow-up in 171 operated patients].

171 children aged 2-17 years underwent cardiac valve replacement between 1969 and December 1979. Valve lesions were of rheumatic origin in 160 and congenital in 11 cases. Single valve replacement of the mitral valve was performed in 116 cases, of the aortic valve in 18 cases and of the tricuspid valve once. Double valve replacement was done in 33 and triple valve replacement in 2 cases. Starr Edwards prostheses were used in most instances. Operative mortality was 5.9% and late death occurred in 8.7%. The follow-up period ranged from 1-9 years with a mean of 3.6 years. The majority of children have returned to a normal lifestyle and are symptom-free. Only 10% remain digitalized. As in adults, the most frequent complications were thromboembolic. 14 children (11%) had either an embolus or a valve thrombosis with a frequently of 3 per hundred patient-years. Other complications such as endocarditis or paravalvular leak were infrequent, and in most cases treatment was successful. Because of the markedly dilated hearts before operation it was possible in most children to use an adult size prosthesis, especially in the mitral position. Only a few children below 5 years of age received small mitral valve prostheses; they may need to be replaced ultimately by larger ones. Introduction of an embolus-free valve prosthesis for children would be a major advance. Unfortunately, porcine xenografts with their low embolic risk are not suitable for children as they often undergo rapid calcification.

Adolescent↗