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Biomedical subjects

P Barragan

Publications and source records attributed to P Barragan.

30 records · Page 2Linked to original sources
PubMed1994

Ticlopidine and subcutaneous heparin as an alternative regimen following coronary stenting.

Subacute thrombosis of coronary stents may occur up to the end of the first month after their implantation and remains the major problem associated with the technique. A cohort of 238 patients with placement of one or more stents in 244 arteries was monitored for this period. All patients were given 500 mg/day of ticlopidine (started 3 days before) and a push dose of 10,000 IU of heparin during the procedure, then 1,000-1,500 IU/hr for 20 hr. Following removal of the arterial introducer, they were kept on subcutaneous heparin for 1 week and ticlopidine (500 mg/day) for 3-6 months. Nine patients (3.8%) showed evidence of thrombosis at 7 days. The overall thrombosis rate at 30 days was 4.2% (3.5% for elective stents, as compared with 7.9% associated with occlusive dissections). Emergency treatment by further angioplasty (8 cases) and intracoronary thrombolysis (5 cases) was undertaken. Complications were as follows: 5 deaths (2%), 3 MI (1.2%), 2 non-Q MI (1.7%). Three predictive factors for subacute thrombosis were identified: age < 70 (p = 0.00006), unstable angina (p = 0.006) and arterial diameter less than 3 mm (p = 0.043). The peripheral vascular complication rate was 4.6%. This study suggests that preventive treatment with ticlopidine appears to reduce the incidence of subacute thrombosis of stents in patients > 70 years of age. Furthermore, the combination of ticlopidine and heparin facilitates laboratory monitoring after stenting. Stenting is thought to represent definitive treatment in situations where placement for occlusive dissection is the indication.

Adult↗
PubMed1994

[Pilot study of the efficacy of ticlopidine in early patency of coronary endoprostheses].

Subacute thrombosis of coronary stents is the main complication of this technique. The authors studied the outcome of 387 patients and 400 coronary arteries who underwent implantation of 427 stents between December 1989 and February 1994 and followed up one month after the procedure: all patients receive 500 mg of ticlopidine daily from three days before angioplasty throughout the hospital period and continued for at least one month. Anticoagulation with heparin was undertaken by the intravenous route after implantation and relayed with subcutaneous heparin for one week until control coronary angiography performed in the first 300 patients. At one month, 96.9% of patients were free of clinical coronary events. The following major complications were observed: 5 deaths (1.3%), 5 Q wave myocardial infarctions (1.3%); no emergency bypass surgery. The peripheral vascular complication rate was 3.6%. Univariate analysis three risk factors of subacute thrombosis: age (p = 0.0058), arterial diameter of less than 3 mm (p < 0.01) and implantation for occlusive dissection (p = 0.03). Multivariate analysis showed two independent risk factors: age (p = 0.001) and arterial diameter of less than 3 mm (p = 0.01). This pilot study shows a particularly low subacute thrombosis rate in unselected indications with an acceptable level of vascular complications.

Adult↗
PubMed1993

Cardioprotective effect of intracoronary nifedipine during percutaneous transluminal coronary angioplasty. A French double-blind cross-over multicentre study.

The aim of this double-blind, placebo-controlled, cross-over study was to assess the cardioprotective effect of intracoronary nifedipine during percutaneous transluminal coronary angioplasty balloon occlusion. A balloon inflation without drug injection was initially made to ascertain that a shift of the ST segment (> or = 2 mm, 0.08 s after the J point) appeared (inclusion criterion). Two other balloon inflations were preceded by intracoronary injection of either 0.2 mg nifedipine or placebo, distal to the stenosis through the balloon catheter. The evaluation criteria were (1) time to ST segment shift, and (2) maximal amplitude of ST segment shift caused by balloon occlusion. Comparison of the data used an analysis of variance. Sixty-seven patients (mean age 54 +/- 8 years; 54 male, 13 female) were studied; 50 patients had 1-, 16 patients 2- and 1 patient 3-vessel disease. The dilated vessel was the left anterior descending coronary artery (n = 51), the right coronary artery (n = 12) and the left circumflex coronary artery (n = 4). Balloon inflation time was 100 +/- 31 s in the nifedipine group and 93 +/- 29 s in the placebo group. Five patients were excluded (procedure stopped after the first inflation in 1 and ST segment shift < 2 mm during the first inflation in 4). The time to 2-mm ST segment shift was longer in the nifedipine group than in the placebo group (62 +/- 40 s versus 51 +/- 40 s, P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Post-traumatic fistula of the left anterior descending coronary artery and left ventricle. Apropos of a new case].

The authors report the case of a 23 year old man who presented with a continuous murmur five years after closed chest trauma. The electrocardiographic and echocardiographic findings indicated previous apical myocardial infarction. The underlying diagnosis was first suggested by continuous wave Doppler which showed systolo-diastolic flow in the septo-apical region directed towards the left ventricle (LV) in diastole. Color Doppler flow studies showed a mosaic pattern opposite a dilated left anterior descending (LAD) artery. These signs of LAD-LV fistula with a single orific were confirmed at coronary arteriography. The patient's previous history was in favour of a traumatic etiology. In the absence of left ventricular failure and myocardial ischaemia by coronary steal, surgery was deferred; Doppler echocardiography would seem to be a good method of following up the fistula and its consequences on left ventricular function. A traumatic left coronary to left ventricular fistula is an extremely rare condition and merits publication. The authors review the literature and describe the physiopathology, diagnosis and therapeutic indications of these fistulae.

Adult↗
PubMed1989

[Septal rupture repaired in the acute stage of myocardial infarction. Clinical, hemodynamic and angio-coronarography findings in the evaluation of surgical risk].

Between 1977 and 1987, 27 consecutive patients (16 men, 11 women, mean age 66 years, range 54 to 75 years) with ventricular septal rupture complicating acute myocardial infarction underwent surgical repair. The purpose of this retrospective study was to analyse the post-operative mortality factors from clinical, haemodynamic and operative data in all patients and also from coronary angiographic data in 23/27 patients whose haemodynamic status allowed this type of exploration. Seventeen patients (63 p. 100) died during the first post-operative month, 10 survived and were discharged. Factors that influenced the prognosis were: (1) inferiorly-located necrosis associated with a 75 p. 100 mortality rate (9 out of 12 patients), as opposed to 53 p. 100 (8 out of 15 patients) with anterior necrosis; (2) right ventricular dysfunction, observed in 83 p. 100 of patients with inferior necrosis and 53 p. 100 with anterior necrosis, which was responsible for 7 out of 9 deaths in the inferior necrosis subgroup and contributed to 3 out of 8 deaths in the anterior necrosis subgroup; this established a cause-effect relationship between right ventricular function and the overmortality of patients with inferior necrosis; (3) independently of the haemodynamic status, two- and three-vessel lesions (56 p. 100 of all lesions) which had an 84 p. 100 mortality rate as opposed to 40 p. 100 with one-vessel lesions; (4) the presence of a state of shock which was associated with a 78 p. 100 mortality rate as opposed to 55 p. 100 in patients without shock. We conclude that when permitted by the patient's haemodynamic status coronary angiography should be part of the pre-operative evaluation to assess the operative risk and guide the surgical procedure.

Acute Disease↗
PubMed1989

[Atrioventricular block, a complication of radiotherapy of the mediastinum].

Cardiac complications of mediastinal irradiation usually concern the pericardium, the ventricular myocardium and the coronary arteries. We report the case of a 42-year old woman who experienced a syncopal atrioventricular (AV) block 12 years after irradiation of a mediastinal Hodgkin's lymphoma. Electrophysiological recordings showed infranodal conduction disturbances. A review of the literature yielded only 12 cases of syncopal radiation-induced AV block. This case highlights the risk of syncopal AV blocks occurring a long time after mediastinal irradiation and leading to severe damage of the His bundle and its branches. The presence, as in our patient, of an associated right ventricular outflow tract stenosis confirms the importance and severity of radiation-induced cardiac lesions.

Adult↗
PubMed1989

[Percutaneous coronary transluminal angioplasty with extracorporeal circulation: preliminary results].

Percutaneous transluminal coronary angioplasty (PTCA) in patients with low ejection fraction (EF) and/or a large area of remaining viable myocardium served by the target vessel can cause hemodynamic collapse in case of acute closure. We report 11 patients in whom the cardiopulmonary bypass support (CPS) was instituted because of contraindication to surgery (Group I) or unstable angina associated with low EF and/or a large amount of myocardium perfused by the target artery (Group II). Nine were male and 2 female, mean ages of 70, with Canadian angor class I (1), II (1), or IV (9) and EF ranging from 12 to 65% (mean 34%). Thirty were the lesions to dilate; 28 were dilated successfully; in 2 an aortic dilation was also performed. One death occurred after the procedure related to collapse due to hypovolemia; another death occurred 8 months after PTCA because of pulmonary neoplasia. The other 9 patients followed-up at 1 to 8 months (mean 3.9) disclosed Canadian angor class I. The procedure's technique and the related complications are discussed. We conclude that cardiopulmonary bypass support can be used safely in patients refused to surgery and with high risk PTCA; such a procedure may expand the indication of PTCA.

Aged↗
PubMed1988

[Cardiac Doppler in the selection of patients for aortic valvuloplasty. Comparison with data of phonomecanograms].

Between December 1986 and August 1987, 34 patients referred for aortic valvuloplasty, undergo before catheterization an ultrasonocardiography with continuous and pulsed Doppler study and a phonocardiography for 22 of them. They all present functional and physical signs of aortic stenosis. The cardiac Doppler enables a positive diagnosis in all patients, while the phonocardiography recordings fail to recognize a tight aortic stenosis. On the other hand, the Doppler enables a diagnosis of severity well correlated with the catheterization (r = 0.88 for maximum instantaneous gradients) in 30 patients: in four patients, the correlation could not be calculated because of technical problems related to the catheterization (2 patients) or the ultrasonic examination (2 patients). From this study, it results that the cardiac Doppler may perfectly select patients who are to undergo an aortic valvuloplasty, unlike phonocardiography.

Adult↗
PubMed1987

[Percutaneous aortic valvuloplasty by trans-septal approach].

Aortic valvuloplasty has recently been introduced in the treatment of some cases of aortic stenosis. In the case reported here, the aortic orifice was so difficult to traverse by the retrograde route that the obstacle was approached by trans-septal catheterization. The aortic area, initially estimated at 0.25 cm2, increased to 0.82 cm2 at the end of the examination. However, additional dilatation by the retrograde route was necessary, using a catheter 25 mm in diameter.

Angioplasty, Balloon↗
PubMed1987

[Evaluation of the prognosis of mitral valve prolapse].

It is not easy to evaluate the prognosis of mitral valve prolapse. First of all, a positive diagnosis is difficult: the clinical insufficiencies are ill-compensated by sonocardiography as it is less reliable than expected; the very existence of the "mitral valve prolapse" described by Barlow is being challenged. Secondly, the most severe complications of mitral prolapse are rare, with respect to its frequency. Some complications are currently well defined. Thus, severe mitral insufficiency, leading to valve replacement, affects elderly men more than young women, although the pathological lesions correspond to the same disease. Endocarditis is rare and only occurs when there is an audible murmur. Rhythm disorders are varied, with however, frequent junction tachycardias and a marked influence of catecholamines, which may explain the clinical effectiveness of beta-blockers. Unfortunately, severe complications are not as well known. Thus, the risk of sudden death and cerebral vascular accident cannot be figured out from large statistical studies. Only studies of some so called "risk" sub-groups, should allow a better knowledge of these two complications and a more effective prevention.

Humans↗
PubMedDate not supplied

[Acute occlusion of the renal artery caused by an embolism of cardiac origin. Treatment by in situ thrombolysis].

An intra-arterial infusion of streptokinase successfully dissolved a large thrombus of the renal artery in a 54-year old male patient with old-standing mitral stenosis. This case illustrates the effectiveness of fibrinolysis in situ. This method provides complete arterial recanalization and preserves the renal function, thus enabling surgical embolectomy to be performed.

Acute Disease↗