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Biomedical subjects

P Brule

Publications and source records attributed to P Brule.

10 recordsLinked to original sources
PubMed1994

Bipolar intramyocardial electrogram from an implanted telemetric pacemaker for the diagnosis of cardiac allograft rejection.

Noninvasive detection of acute cardiac allograft rejection remains a challenge. Analysis of the epicardial electrogram transmitted by unipolar telemetric pacemaker can be of help in the detection of rejection with myocytolysis but is hampered by extracardiac factors. Instead, the contribution of a bipolar pacemaker for this purpose was studied. The bipolar peak-to-peak amplitude of epicardial electrograms (BPPA) from 25 patients implanted with a bipolar pacemaker at the time of heart transplantation was measured at the time of endomyocardial biopsies. BPPA was expressed as a percent of the baseline value. A voltage drop of more than 10% was considered an indication of rejection. Of 118 biopsies, 80 were free of rejection and 38 showed mild to moderate rejection (Grade 1A = 12; Grade 1B = 17; Grade 2 or 3 = 9). The mean value of BPPA was less for grade 2 biopsies (86.4 +/- 17%) than for biopsies with no or mild rejection (101.3 +/- 14.3% for Grade 0, 101.4 +/- 13.8% for Grade 1A, and 98.6 +/- 18% in Grade 1; P < 0.05). Diagnostic concordance between BPPA measurement and biopsy results increased with the histological severity of rejection (Grade 1A = 1/12, Grade 1B = 5/17, Grade > 2 = 7/9). Acute rejection was diagnosed with a sensitivity of 34% for Grade 1A, 46% for Grade 1B, and 78% for rejection episodes with myocytolysis (Grade > or = 2). Specificity remained approximately 90% for all histologic grades.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1989

[Peroperative ultrafiltration in complete repair of ventricular septal defect in infants].

Ventricular septal defect in infants induces peroperative fluid overload (particularly extravascular lung water overload) which causes some morbidity after surgical closure of the defect. Thirty infants undergoing the conventional complete correction procedure were retrospectively compared with 32 infants operated upon using ultrafiltration at the end of the cardiopulmonary bypass. There was no difference between the two groups in biological data, haemodynamic parameters and either morbidity or mortality. Nevertheless, a clinical impression of smooth follow-up in patients with ultrafiltration encourages to carry out a prospective and randomized study.

Extracorporeal Circulation↗
PubMed1988

[Aortic valve replacement using the Björk-Shiley valve. Long-term results (268 patients)].

From 1974 till November, 1986, 268 adult patients aged from 15 to 84 years (11 p. cent over 70) underwent isolated aortic valve replacement by Björk-Shiley prosthesis. 81 p. cent of the prosthetic valves implanted were size 21 or over. The initial lesion was aortic stenosis (AS) in 40 p. cent, aortic regurgitation (AR) in 35 p. cent and aortic disease (AD) in 25 p. cent of the cases. The aortic valve lesions were degenerative (46 p. cent), rheumatismal (18 p. cent), congenital (12 p. cent), infective (19 p. cent including acute infective endocarditis) or dystrophic (7 p. cent) in origin. Pre-operatively, 54 p. cent of the patients were in NYHA functional class III and 14 p. cent in NYHA functional class IV. 7 p. cent presented with permanent atrial fibrillation. Mean pre-operative cardiac index was 2.49 1/mn/m2. Peri-operative mortality (up to 30 days) was 7.09 p. cent in both the 1974-79 period and the 1980-86 period; it was 3.4 p. cent in AS, 7.4 p. cent in AD and 10.7 p. cent in AR. The 249 survivors were followed up for a mean period of 5.3 years, or 1313 patient-years. 30 patients (11 p. cent) died subsequently (11 of prosthesis-related cause), giving an actuarial survival rate of 81.7 p. cent at 5 years and 71.4 p. cent at 10 years. 12 patients were reoperated upon, including 2 for prosthesis-related reasons (2.4 p. cent patient-years).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

[Congenital aortic valve stenosis. Long-term results after valvulotomy].

The cases of 73 patients undergoing valvulotomy for congenital valvular aortic stenosis between 1957 and 1982 were reviewed. Data was updated after recalling patients to the outpatient clinic and/or analysis of the results of a questionnaire sent to the patient's family doctor or cardiologist. Babies less than 12 months old at the time of surgery were excluded from the study. Operation consisted of valvulotomy under direct control with few associated procedures as the valvular lesion was isolated in 89 p. 100 of cases. 5 patients died in the first 30 postoperative days, an operative mortality of 5,4 p. 100. The follow-up period ranged from 1 to 25 years, with 15 patients having been followed up for over 10 years. 6 patients were reoperated with no operative mortality. 2 of whom have since undergone a second reoperation. Of the 59 patients not re-operated, 54 were class I and 5 class II of the NYHA. Of the latter group, 4 are candidates for aortic valve replacement for significant aortic regurgitation. The actuarial survival graph shows a 92.82 p. 100 probability of survival at 5 years, and 86.83 p. 100 at 10 years. Aortic valvulotomy remains a palliative operation which does not protect the patient from subsequent sudden death.

Adolescent↗
PubMed1981

[Haemodynamic effects of dopamine, sodium nitroprusside and the association dopamine-sodium nitroprusside. Comparison of their effects after extra-corporeal circulation under deep hypothermia for congenital heart defects in infants and small children (author's transl)].

Heart rate, cardiac index measured by thermodilution, systolic diastolic and mean arterial pressure, mean left and right atrial pressures, were measured immediately before and after 30 minutes of dopamine infusion at a rate of 7 micrograms/kg/minute, then after 30 minutes of nitroprusside infusion at a rate of 0.5 micrograms/kg/minute, and after 30 minutes of association dopamine-nitroprusside at the same doses. The statistical analysis shows that the best enhancement in the cardiac output is observed (P less than 0.01) after the association dopamine-nitroprusside, with a diminution of systemic vascular resistance (P less than 0.05) however less important than that observed with sodium nitroprusside alone (P less than 0.025).

Child, Preschool↗
PubMed1980

[Anomalous origin of the left coronary artery from the pulmonary artery. Treatment by left subclavian-left main coronary artery anastomosis].

The technique of left subclavian-main left coronary artery is described as the treatment of anomalous origin of the left coronary artery from the pulmonary artery, without the aid of cardiopulmonary bypass, which, however, remains on standby. Through a left postero-lateral thoracotomy, the left main coronary artery is detached from the main pulmonary artery with a cuff of pulmonary wall after lateral clamping of the pulmonary artery. Tapes are encercling the pulmonary artery and the descending thoracic aorta, making them ready for an eventual connection to the standby bypass, in case the coronary clamping is not well tolerated. The anastomosis between the left subclavian artery dissected free and the prepared left main coronary artery is then possible and easy even in a small infant. This technique has been used in three infants aged three to thirty months without any mortality nor particular morbidity.

Child, Preschool↗