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Biomedical subjects

M Pasque

Publications and source records attributed to M Pasque.

7 recordsLinked to original sources
PubMed1999

Prevalence of left ventricular diastolic filling abnormalities in adult cardiac surgical patients: an intraoperative echocardiographic study.

The incidence of left ventricular (LV) diastolic abnormalities in adult cardiac surgical patients has not previously been adequately investigated. The present study was performed to characterize LV diastolic filling patterns by performing transesophageal Doppler echocardiographic (TEE) studies in patients undergoing cardiac surgical procedures and thus indirectly assess diastolic function in these patients. Doppler TEE studies were performed and transmitral flow (TMF) and pulmonary venous flow (PVF) velocities were recorded in 104 patients intraoperatively. Peak early (E) and late (A) TMF velocities and systolic (S) and diastolic (D) forward PVF velocities were assessed and deceleration time (DT) was measured in all patients. For analysis, the study patients were classified into three groups according to the ratio of the TMF E to A velocity curves: group I with E/A ratio less than 1.0, group II with E/A ratio of 1.0 to less than 2.0, and group III with E/A ratio of 2.0 or greater. A filling pattern of abnormal LV relaxation was found in 73 patients (E/A < 1.0), a normal or pseudonormal pattern was present in 27 patients (1.0 < or = E/A < or = 2.0), and restrictive filling in 4 patients (E/A > 2.0). Patients with impaired relaxation had a greater incidence of recent myocardial infarction and congestive heart failure (CHF) than those with normal or pseudonormal filling patterns. Within group II, patients with CHF had higher TMF E deceleration rates and lower PVF S/D ratios compared with those without CHF (P < .05). Doppler echocardiographic examination of TMF and PVF velocities suggests that abnormalities in diastolic function are prevalent in adult cardiac surgical patients.

Aged↗
PubMed1990

Free and total lidocaine levels in cardiac surgical patients.

A lidocaine bolus of 2 mg/kg has been shown to decrease the incidence of ventricular fibrillation in cardiac surgical patients during reperfusion following aortic cross-clamp release (CCR). In an effort to extend this effect into the immediate postoperative period, many centers routinely administer a prophylactic lidocaine infusion for the first 12 to 24 hours after surgery. Sequential total serum lidocaine levels were measured over 6 hours in 28 adult cardiac surgical patients without liver, kidney, or respiratory disease, and free serum lidocaine levels were measured in 15 of these patients. In addition, pharmacokinetic data were collected and analyzed in 8 of these patients. Each patient received a lidocaine bolus of 1.5 mg/kg and an infusion at 2 mg/min immediately before CCR. Serum levels were determined just before CCR, and at 10, 20, 30, 60, 120, 240, and 480 minutes after CCR. More than 50% of patients had subtherapeutic total serum lidocaine levels from 20 to 120 minutes after CCR, but free lidocaine levels remained within the therapeutic range. No patient showed malignant ventricular dysrhythmias during the study. The results suggest that (1) it may be misleading to estimate free lidocaine concentration based on total lidocaine levels; and (2) free drug is the moiety responsible for lidocaine's antiarrhythmic effect.

Adrenergic beta-Antagonists↗
PubMed1987

Tricuspid valve replacement in children.

Between 1974 and January, 1986, 11 children underwent 13 tricuspid valve replacements at the Hospital for Sick Children in Toronto. Age at operation ranged from 24 hours to 14.5 years (mean, 6.9 years). Morphology of the tricuspid valves included Ebstein's anomaly (6 patients), congenital tricuspid regurgitation (3), tricuspid regurgitation and univentricular heart (1), and previous tricuspid valve excision for acute endocarditis (1). There were 4 early deaths: the 3 youngest infants in the series (age 1 day to 16 days) and another child who underwent emergency valve replacement died. On follow-up to 13 years after valve replacement, there were 2 late deaths and two reoperations. Both reoperations were for calcified degenerative tissue prostheses 6.5 and 9 years following implantation. The estimated 5-year survival based on a collected review of data from the literature is 68 +/- 9% for children with prosthetic tricuspid valves. Although tissue valve durability is better in the tricuspid position than on the systemic side of the circulation, calcification does result in late dysfunction. Tricuspid valve repair should always be carried out when possible, especially in the infant group. Elective prosthetic valve replacement in older children can be performed with reasonable operative risk and reasonable late results.

Child↗