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Biomedical subjects

P Meimoun

Publications and source records attributed to P Meimoun.

14 recordsLinked to original sources
PubMed2005

[Value of coronary reserve flow measurement by transthoracic echocardiography].

The measurement of coronary reserve flow by transthoracic echocardiography of the left anterior descending and the posterior interventricular artery is a new non-invasive reproducible and attractive method which can be performed at the bedside with the proviso of a specific learning curve. The potential value is great: detection of significant (> 70%) coronary stenosis, coronary occlusion, post-angioplasty follow-up, evaluation of intermediate stenoses, coupling with stress echo, reperfusion studies, no reflow detection, post-infarction viability, coronary bypass patency and studies of microcirculation.

Coronary Artery Bypass↗
PubMed2004

[Measurement of coronary flow and flow reserve with transthoracic echocardiography: an old concept, a new tool, a lot of applications].

Non invasive evaluation of coronary flow and flow reserve by using transthoracic echocardiography is a promising method for evaluating coronary disease. Left anterior descending and right posterior descending coronary flow are accessible in the majority of patients. This technique is useful in various settings: detection of coronary artery stenosis, coronary occlusion, follow up after percutaneous coronary intervention, evaluation of the significance of coronary stenosis of intermediate severity, evaluation of the microcirculation, study of reperfusion and no reflow in the acute phase of myocardial infarction, evaluation of bypass grafts, improvement of the diagnostic accuracy during stress echocardiography. After a period of training, it's possible to change an old concept, formerly not easily accessible in clinical practice, into a useful and modern tool for evaluating coronary artery disease.

Coronary Circulation↗
PubMed2003

[Dyspnea of effort with an unusual cause: diagnostic significance of stress echocardiography].

Left intra ventricular obstruction occurring during doubutamine stress echography is not exceptional but its clinical significance is controversial, notably due to the non-reproducibility of such a phenomenon during physical exercise in a certain number of patients. Moreover, in the studies which demonstrate a link between symptoms of effort and left intra ventricular obstruction during dobutamine echography, an echography with effort was not systematically performed in order to confirm this relationship. We describe the case of two patients, aged 50 and 62 years respectively, with no notable cardiovascular past history except hypertension, who had dyspnoea of effort in the absence of underlying cardiopathy in resting conditions. Dobutamine stress echography provoked a systolic anterior movement of the mitral valve (SAM) responsible for mitral insufficiency and significant left intra ventricular obstruction (maximum gradient of 77 mmHg for one, 130 mmHg for the other), with reproduction of spontaneous symptoms, in the absence of myocardial ischaemia. An effort echography performed several weeks later confirmed these data, even though a sublingual trinitrate (0.3 mg) test was without effect. In the absence of underlying hypertrophic cardiomyopathy the SAM (with left intra ventricular obstruction and mitral insufficiency) occurring during dobutamine stress echography could have clinical significance in selected cases, notably in hypertensive patients with effort intolerance who have normal systolic and diastolic function in the resting state, and absence of myocardial ischaemia during stress, as illustrated in our two observations. The therapeutic implications are clear, with patients like this successfully treated with beta-blockers.

Cardiotonic Agents↗
PubMed2001

Very long-term results (more than 20 years) of valve repair with carpentier's techniques in nonrheumatic mitral valve insufficiency.

BACKGROUND: Mitral valve repair is considered the gold standard in surgery of degenerative mitral valve insufficiency (MVI), but the long-term results (>20 years) are unknown. METHODS AND RESULTS: We reviewed the first 162 consecutive patients who underwent mitral valve repair between 1970 and 1984 for MVI due to nonrheumatic disease. The cause of MVI was degenerative in 146 patients (90%) and bacterial endocarditis in 16 patients (10%). MVI was isolated or, in 18 cases, associated with tricuspid insufficiency. The mean age of the 162 patients (104 men and 58 women) was 56+/-10 years (age range 22 to 77 years). New York Heart Association functional class was I, II, III, and IV in 2%, 39%, 52%, and 7% of patients, respectively. The mean cardiothoracic ratio was 0.58+/-0.07 (0.4 to 0.8), and 72 (45%) patients had atrial fibrillation. Valve analysis showed that the main mechanism of MVI was type II Carpentier's functional classification in 152 patients. The leaflet prolapse involved the posterior leaflet in 93 patients, the anterior leaflet in 28 patients, and both leaflets in 31 patients. Surgical technique included a Carpentier's ring annuloplasty in all cases, a valve resection in 126 patients, and shortening or transposition of chordae in 49 patients. During the first postoperative month, there were 3 deaths (1.9%) and 3 reoperations (2 valve replacements and 1 repeat repair [1.9%]). Six patients were lost to follow-up. The remaining 151 patients with mitral valve repair were followed during a median of 17 years (range 1 to 29 years; 2273 patient-years). The 20-year Kaplan-Meier survival rate was 48% (95% CI 40% to 57%), which is similar to the survival rate for a normal population with the same age structure. The 20-year rates were 19.3% (95% CI 11% to 27%) for cardiac death and 26% (95% CI 17% to 35%) for cardiac morbidity/mortality (including death from a cardiac cause, stroke, and reoperation). During the 20 years of follow-up, 7 patients were underwent surgery at 3, 7, 7, 8, 8, 10, or 12 years after the initial operation. Valve replacement was carried out in 5 patients, and repeat repair was carried out in 2 patients. At the end of the study, 65 patients remained alive (median follow-up 19 years). Their median age was 76 years (age range 41 to 95 years). All except 1 were in New York Heart Association functional class I/II. CONCLUSIONS: Mitral valve repair using Carpentier's technique in patients with nonrheumatic MVI provides excellent long-term results with a mortality rate similar to that of the general population and a very low incidence of reoperation.

Adult↗
PubMed2001

[Effect of aortic valve replacent for aortic stenosis on cervical arterial blood flow].

Aortic stenosis is known to modify initial upstroke time (IUT) of velocity in peripheral arteries and carotid velocities. The authors conducted a prospective study in 30 patients scheduled for aortic valve replacement for aortic stenosis. The goal was to establish postoperative correction of carotid flow disorders. In the preoperative period, a positive correlation (p < 0.01) was observed between IUT and mean pressure gradient, and a negative correlation (p < 0.02) between IUT and aortic valve area. Post-operatively, the authors observed a large decrease (p < 0.0001) of IUT, and higher (p < 0.05) systolic peaks of velocity (PSV) in all studied arteries. In this article, the authors confirmed the few previous studies which described preoperative velocity modifications in aortic stenosis population, but they also described for the first time their postoperative correction. Therefore, identifying these patterns of peripheral circulatory alterations is important and underestimation of carotid stenosis, currently estimated preoperatively, must be avoided.

Adult↗
PubMed2001

[Coronary bypass surgery on the beating heart and surgery of an abdominal aortic aneurysm. Immediately sequential surgical treatments].

The authors report sequential association during the same general anaesthetic of coronary bypass surgery on the beating heart and surgery of an abdominal aortic aneurysm. Two aorto-coronary bypass grafts were carried out without cardiopulmonary bypass using the two pediculated internal mammary arteries (without manipulation of the ascending aorta), followed, after closure of the chest and monitoring in the operating theatre for one hour, by reinstallation of the patient for treatment of an infra-renal abdominal aortic aneurysm by classical prosthetic implantation. The postoperative course was uncomplicated. Sequential management of coronary revascularisation without cardiopulmonary bypass and aortic aneurysmal lesions during the same anaesthetic provides an alternative to classical two-stage surgery in selected patients.

Aged↗
PubMed2001

[Lyme disease presenting as infarction pain. A case report].

Lyme's disease is a multi-system condition due to infection with a spirochete (Borrelia Burgdorferi), transmitted by a tick. Cardiac involvement, which is not systematic, usually presents with transient atrioventricular block of varying degree. The authors describe an unusual presentation of the cardiac involvement of Lyme's disease with chest pain resembling an acute coronary syndrome in a 32 year old man. The characteristic skin lesion (erythema migrans), the positivity of IgM serology, the myocardial scintigraphic results and the negativity of the work-up of other causes of this pain led to a diagnosis of myocarditis, the outcome of which was favourable with treatment by amoxycillin (3 g/day, orally).

Adult↗
PubMed2000

[Utilization of aortomyoplasty as a biological pumping system].

Aortomyoplasty is a surgical technique of constructing a neo-ventricle on the ascending or descending aorta with the latissimus dorsi muscle. This is electrically stimulated to contract during diastole, thereby creating a system of chronic, haemo-compatible aortic pumping. Long-term experimental studies have shown increases in cardiac output (from 3.6 to 5.5 l/min), decreases in peripheral resistances (from 1574 to 1134 dyne.sec.cm-5) and increases in indices of subendocardial viability (DPTI/TTI: 1.1 to 1.4). These experimental studies have been confirmed by the initial clinical results. To date, world experience includes thirty-six patients. With cardiomyoplasty, aortomyoplasty is a new arm in the therapeutic arsenal against severe cardiac failure by providing a new system of chronic circulatory assistance which is implantable and biocompatible.

Aorta, Thoracic↗
PubMed2000

[Staphylococcus epidermidis infective endocarditis after mitral surgery, successfully treated with aspirin and antibiotics: a case report].

We report a case of infectious endocarditis from Staphylococcus epidermidis that occurred early after mitral valve repair (one month), suggested by fever of 38.5 degrees C and valvular vegetations of less than 10 mm on the mitral valve. In the absence of standard recommendations (medical or surgical) in treating patients with infectious endocarditis occurring after mitral valve repair, and in the absence of complications, a medical regimen was chosen associating aspirin (anti-aggregant dosages) with antibiotics. The benefit of aspirin in endocarditis has been demonstrated in experimental studies with regards to valvular vegetations and embolic risk but remains to be studied in human clinical trials. With the association of aspirin (100 mg/d) and triple antibiotic therapy (rifampicin 1200 mg/d, vancomycin 2 g/d, gentamycin 180 mg/d), the clinical status improved with complete regression of vegetations in less than 24 days and the absence of recurrence at one-year follow-up.

Adult↗
PubMed1999

[Stenotrophomonas maltophilia endocarditis following mitral valve prosthesis implantation. Report of a case].

The authors report the first case of early postoperative endocarditis after mitral valvuloplasty due to Stenotrophomonas Maltophilia, a Gram negative organism, in a 37 year old man with no special risk factors. Pyrexia and mitral valve vegetations were the main features, and, in the absence of complications or of embolism, the patient was treated initially with triple antibiotherapy (ceftazidime, amikacine, ciprofloxacine). Relapse two weeks after withdrawal of treatment due to two variants of Stenotrophomas Maltophilia, one of which was resistant to ciprofloxacine, and the presence of a large vegetation, required repeat mitral valvuloplasty and a change in antibiotic therapy (ticarcilline with clavulanic acid, trimethoprim sulphamethoxazole, colistine). This time, the outcome was good. The little known Stenotrophomonas Maltophilia infectious endocarditis is a serious complication and, in the absence of standardised management, the authors suggest that, in view of the multi-resistant character of the organism and in the light of this case, surgery should be considered in association with prolonged antibiotic therapy.

Adult↗
PubMed1998

[Dynamic left intraventricular obstruction after reconstructive mitral valve surgery].

A 71-years-old patient, undergoing mitral valve repair for degenerative valvulopathy and correction of pectus excavatus experienced a cardiogenic shock after weaning from cardiopulmonary bypass. The shock occurred after calcium chloride administration and was unresponsive to inotropic drugs. Transoesophageal echocardiography showed left ventricular outflow tract obstruction due to systolic anterior motion (SAM) of the mitral valve. Discontinuation of inotropic drugs and volume expansion restored the haemodynamic status. By its haemodynamic effects calcium chloride can cause left ventricular outflow tract obstruction, recognized by transoesophageal echocardiography.

Aged↗