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P Mesnildrey

Publications and source records attributed to P Mesnildrey.

At least 19 recordsLinked to original sources
PubMed1992

[Early postoperative thrombolysis of Saint-Jude aortic valve prosthesis].

The authors report a case of thrombolytic therapy with streptokinase in the early postoperative period after aortic valve replacement with a Saint Jude medical prosthesis. After good initial progress, the patient had to be reoperated on the 12th postoperative day for sternal disunion. Reoperation was followed rapidly by progressive thrombosis of the aortic prosthesis demonstrated by repeated Doppler echocardiographic examination. The impossibility of eliminating mediastinitis led to medical thrombolysis. The outcome was favourable after a regressive cerebral embolic event. This case illustrates the value of Doppler echocardiographic examination in the postoperative period. Thrombolysis may constitute an alternative to reoperation when the operative risk is high. The risk of thrombolysis may not be as great as some believe.

Echocardiography, Doppler↗
PubMed1990

[New valvular homografts. Prospects and limits of their viability. Report of 42 implantations].

The regain of interest in aortic homograft bioprostheses is related to the prospects of improved viability resulting from explanation from organ donors, preservation in rich tissue culture media, together with the progress made in techniques of cryopreservation. Viability studies examining morphology of electron microscopy and tests of tissue culture confirm this notion of longer viability. These properties raise hopes of satisfactory long-term results while acknowledging outstanding antigenic problems which require strict A-B-O system compatibility. The results of a preliminary series of 42 valve homografts implanted at Henri Mondor Hospital over the last 5 years are reported. Twenty-one bioprostheses were implanted on the right side in congenital heart disease with good results in every case. Twenty-one were implanted in the aortic position in children and show no signs of degeneration as yet. One poor result was related to a technical error in calibration. The rebirth of this technique raises certain hopes, especially in aortic valve replacement.

Adolescent↗
PubMed1990

[Viability of new valvular homografts. An evaluation at the Henri Mondor Hospital].

The renewed interest in valvular homograft is due to the new concept of their viability. This viability requires procurement from organ donors and preparation in rich tissue culture medium immediately prior to cryopreservation. This viability, confirmed by morphological tests especially electron microscopy, and by cell culture tests is the basis for satisfactory long-term results. Antigenic aspects justify rigorous respect of A-B-O compatibility. A preliminary clinical series of 35 valvular homografts (16 on the right side and 19 in the aortic position), implanted especially in children over the last five years at the Henri Mondor Hospital, is reported here, No tissue failures have been reported to date.

Aortic Valve↗
PubMed1989

[Echocardiographic-Doppler study of a case of subacute and incomplete parietal rupture after myocardial infarction].

The authors report the case of a 55 year old man who suffered a silent, laterobasal myocardial infarction which was complicated by a subacute pseudo-false aneurysm of the lateral wall of the left ventricle. They underline: The importance of two-dimensional echocardiography in the diagnosis of a neo-para left ventricular cavity showing systolic expansion and communicating with the left ventricle by a narrow neck indicating rupture of the free ventricular wall; The value of two-dimensional color coded Doppler which enables the operator to distinguish the active nature of the neo-left ventricular cavity before surgery and its inactivity after surgery. The surgical indication for emergency resection of the pseudo aneurysm was based on these preoperative non-invasive observations. This case confirms the value of cardiac two-dimensional echo-Doppler studies in the investigation of ischaemic heart disease.

Aged↗
PubMed1989

[Viability of new valvular homografts. Myth or reality?].

Use in cardiac surgery of aortic homografts as a valvular substitute is old and was specially developed in France by F. Fontan. In fact, these first allografts were non-viable and the results, in aortic position, were not better than current bioprosthesis. Renewed interest is related to the important notion of "viability" allowed by an immediate procurement (organ donors), preparation in nutrient medium RPMI with low doses of antibiotics and final storage at -196 degrees C (cryopreservation). We have reviewed our initial experience concerning 32 implanted homografts in children either in reconstruction of the right ventricular outflow tract (in many forms of congenital heart disease) or in aortic position. No mortality was observed. The only failure was due to an initial sizing mistake leading to an aortic valve replacement at 13 months. No late deterioration (mean follow-up: 12.5 months) was detected by echocardiography. These results seem to confirm other larger series (as O'Brien's, Brisbane, Australia). Biologic, histological and immunological assessments of "viable" homografts are discussed. The limits of the technique are reported.

Adolescent↗
PubMed1988

Aortic 125I-albumin transport in patients with Marfan's syndrome and annuloaortic ectasia.

The morphologic, biochemical, and mechanical abnormalities of connective tissue fibrous proteins in Marfan's syndrome have been well studied, and their role in cardiovascular complications is well accepted. Less is known, however, about the state of the amorphous components of the aortic connective tissue. In the course of a study of transmural transport in blood vessels, we have had the opportunity to study dystrophic aorta from two young men who survived elective surgery; both with aortic insufficiency (AI) histologically compatible with Marfan's syndrome. One had recurrent chronic dissecting aneurysm (RCDA) as well. The aorta of the first (but not the second) was histologically compatible with Marfan's syndrome. Fresh specimens of intact ascending aorta were incubated in Krebs solution, pH 7.4, containing 125I-labelled bovine serum albumin for 2 h at 37 degrees C. The samples were then frozen, and serially sectioned in the plane of the lumenal surface. The radioactivity of the 20-micron thick sections was then determined, and expressed as a tissue/labelled solution concentration ratio. Transmural profiles of these ratios revealed no difference between the aorta of the RCDA patient with non-specific aortic dystrophy, and that of a 70-year-old man undergoing aortocoronary bypass. However, in the patient with aortic histology compatible with Marfan's syndrome, the average media concentration ratio was 5-fold less (4% vs. 20%).

Adult↗
PubMed1988

Rupture of the right ventricular free wall. An unusual complication of mediastinitis after cardiac surgery.

Of 2171 patients who underwent open heart surgery between 1981 and 1986, 41 (1.8%) developed postoperative mediastinitis and were treated by closed irrigation drainage or open chest therapy. Six patients, (mean age 59 years) developed rupture of the right ventricular free wall. The primary procedures were: resection of akinetic fibrous plaque (2), mitral valve replacement (1), coronary bypass grafting (1), removal of a left atrial myxoma (1) and repair of post-infarction rupture of the left ventricle (1). In 2 patients, rupture occurred in the operating theatre during revision of the irrigation drainage. Both patients died after repair. In 4 patients, rupture occurred during coughing. One died before surgery. In the 3 other cases, the defects were repaired either by direct suture (2 patients) or with a pericardial patch (1 patient) with the aid of normothermic extracorporeal circulation. Three days later, a muscular flap (pectoral or dorso-lumbar) was mobilized to protect the mediastinal viscera. All 3 patients are alive and well. When bleeding occurs during treatment of mediastinitis, an immediate exploration with extracorporeal circulation to close the defect should be considered.

Aged↗
PubMed1988

[Aortic subvalvular obstructions. Anatomical forms and surgical treatment of 82 consecutive cases].

The authors report their experience of surgery for subvalvular aortic obstruction in 82 patients aged from 4 to 44 years (mean 15 years). Nearly one-half of the patients presented with symptoms; the others were operated upon for various reasons: gradient exceeding 60 mmHg, development or aggravation of aortic regurgitation, positive exercise test, electrocardiographic or echocardiographic signs of left ventricular repercussions. Nineteen children had previously undergone surgery for another malformation, but the subvalvular aortic obstruction had either been missed during this first operation or had developed subsequently. The diaphragmatic pattern was the most frequent (62 cases); the fibromuscular pattern was less common (9 cases) and the tunnel pattern (6 cases) was regularly associated in this series with hypoplasia of the aortic ring. Obstruction due to faulty insertion of the mitral valve was encountered on 3 occasions. The operative technique for each anatomical pattern is described. Tunnel obstructions did not require primary aortoventriculoplasty without prosthetic valve replacement of apicoaortic conduits. In addition to treatment of associated lesions (including 4 cases of ventricular septal defect), 9 aortic commissurotomies, 6 aortic valvuloplasties and 4 aortic valve replacements were performed. The transaortic gradient was dramatically improved. The aortic regurgitation murmur subsided with or, usually, without valvuloplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Nd-YAG laser-induced injury in dog myocardium: optical and ultrastructural study of early lesions.

To characterize myocardial lesions induced by Nd-YAG laser in vivo, laser pulses were delivered on the epicardial surface of beating dog hearts. Acute lesions were studied at the optical and ultrastructural levels. The size of the lesions depended on the power of the laser beam. Tissue vaporization could be avoided if total delivered energy did not exceed 350 J. Laser energy induced different types of myocardial necrosis distributed in concentric layers of coagulation necrosis, and contraction band necrosis. Thus, laser energy can produce controlled irreversible lesions without crater formation. These effects may be of use in the treatment of arrhythmias.

Animals↗
PubMed1986

[Ventricular tachycardia of ischemic origin. Surgical treatment by encircling thermo-exclusion using the Nd-Yag laser].

Refractory and recurrent ventricular tachycardias are a common cause of death after myocardial infarction. The occurrence of intraventricular re-entries can be prevented by a new surgical treatment based on encircling thermic exclusion. The Nd-YAG laser beam offers 2 major advantages over previous techniques: it acts rapidly with minimal myocardial damage and can even be used in patients with left ventricular dysfunction.

Coronary Disease↗
PubMed1986

Long-term results with total replacement of the ascending aorta and reimplantation of the coronary arteries.

From November, 1976, to June, 1983, 100 patients, 84 male and 16 female patients ranging in age from 13 to 74 years, were operated on for aortic insufficiency associated with an aneurysm of the ascending aorta. Twenty patients were in New York Heart Association Class I, 22 in Class II, 51 in Class III, and seven in Class IV. The surgical treatment in all cases consisted of total replacement of the ascending aorta with a tube graft containing a prosthetic aortic valve and reimplantation of the coronary arteries by an intermediate tube graft according to the technique already reported. In 68 patients an uncomplicated annulo-aortic ectasia existed, and in 32, an aortic dissection; nine of the latter group were operated on during the acute phase. The operative mortality for the entire group was 4% (four deaths). One patient has been lost to follow-up during a period ranging from 18 months to 8 years (average 54 months). The late mortality has been 11/96. Among the 84 survivors, clinical improvement is readily apparent (89% are in Class I or II). Twenty-five patients have been restudied by angiography, which revealed a satisfactory coronary and aortic appearance in all cases with neither stenosis nor aneurysm. The actuarial survival rate is 75% at 8 years. In conclusion, the treatment of aortic insufficiency associated with an aneurysm of the ascending aorta by insertion of a composite graft and reimplantation of the coronary arteries through an intermediate Dacron tube is a reliable method with low mortality and excellent long-term results.

Actuarial Analysis↗
PubMed1985

Surgery for prosthetic valve endocarditis.

Infectious endocarditis is the main complication after prosthetic valvular replacement. 2 problems remain unsolved: 1. Diagnostic: Fever, heart failure and paravalvular leaks should be indications for re-operations. 2. Technical: perfect fixation of the prosthetic valve is a surgical challenge. The difficulties as shown here are the cause for so many operative techniques. Early surgical intervention is the best method to prevent myocardial failure.

Abscess↗
PubMed1985

[Surgical result of 48 Bigelow myotomies for obstructive myocardiopathy].

Bigelow's myotomy is one of the surgical options available for the treatment of hypertrophic obstructive cardiomyopathy (HOCM). The results of this operation were analysed in 48 cases operated between 1965 and May 1983. The average age of the patients was relatively low (38 years) but preoperative symptoms were severe (34 patients in Class III and 6 patients in Class IV of the NYHA Classification). The diagnosis was confirmed in all cases by echocardiography, carotid pulse tracings and cardiac catheterisation. 28 patients had associated lesions including 21 cases of mitral regurgitation (minimal in II cases, moderate in 6 cases and severe in 4 cases). All patients underwent Bigelow myotomy which was associated with a complementary procedure in 9 cases (including 2 mitral valve replacements and 2 semi-circular annuloplasties). The hospital mortality was 6 patients; surgical morbidity resulted from permanent intraventricular conduction defects (27 cases). At long-term, 3 more patients died, 2 from cardiac causes. Of the remaining 39 patients followed-up for an average of 32 months, functional improvement was marked, except in very advanced stages of the disease (Class IV) or forms with severe or uncorrected mitral regurgitation. The indications for Bigelow myotomy are discussed with reference to three parameters of HOCM (intraventricular pressure gradient, mitral regurgitation, decreased left ventricular compliance). This procedure has a beneficial effect on the subaortic stenosis and left ventricular compliance. It should be completed by mitral valve surgery in patients with significant regurgitation.

Adolescent↗
PubMed1985

[Repeated valvular replacements].

After more than two decades of cardiac valve replacement surgery, the number of reoperations has increased and third or even fourth replacements are no longer rare occurrences. Of the 2072 valves prostheses implanted at the Hôpital Foch between 1970 and December 1984, 134 (6.4%) have been changed at least once and 27 prostheses (1.3%) have been replaced three or more times in 23 patients. Eighteen patients were operated on three times and 5 patients 4 times, a total of 73 operations. Ten patients had aortic valve prostheses, 7 had mitral valve prostheses and 6 had double aortic and mitral valve prostheses. The technical difficulties due to previous cardiac surgery were not great or easily surmounted as every procedure was performed by a median sternotomy and only 2 out of 50 required cannulation of the femoral vessels for cardiopulmonary bypass. The repair itself consisted of simple valve replacement in 3 out of 4 cases (30 single and 3 double valve replacements, 3 valve reinsertions). The other operations required more complex techniques such as remodelling of the ring of insertion or the use of a valved tube. None of the patients died in the operating theatre. However, 3 patients died during the hospital period (13%) and there were 2 late deaths (10%) and 1 patient (5%) was lost to follow-up. The 17 survivors were followed up for 3 to 148 months (average 42 months). Half the patients are now in functional Classes I or II of the NYHA classification. These results show that repeated valve replacement has an acceptable operative risk.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve↗
PubMed1985

[Recurrent post-infarction ventricular tachycardias. Treatment combining circular ventriculotomy, myocardial revascularization and aneurysmal plication].

The efficacy of encircling endocardial ventriculotomy (EEV) with treatment of recurrent persistent post-infarction VT has been established. The relative simplicity of the operation has enables it to be easily integrated into the surgical therapeutic arsenal for the treatment of coronary artery disease and its complications. Several electrophysiological studies have clearly demonstrated the origin of reentry pathways in the border zone of the aneurysm so that peroperative mapping can be dispensed with except in special cases. Sixteen patients with post-infarction LV aneurysm causing recurrent VT resistant to antiarrhythmic therapy for over 3 months were operated between January 1979 and June 1983. The average age was 51 years, range 36 to 70 years. The causal myocardial infarction dated from 3 months to 22 years; the site of infarction was anterior in 12 cases (anteroseptal 5 cases), posterior in 3 cases and circumferential in 1 case. Surgery was performed under cardiopulmonary bypass and comprised EEV in the border zone of the aneurysm without prior mapping studies. A myocardial revascularisation procedure was associated in 10 cases (aortocoronary saphenous vein bypass) with single grafts in 4 patients. Thirteen patients also underwent plicature of the aneurysm to remodel the ventricular cavity. There was one death in the immediate postoperative period due to a low output state (6.25%). The 15 survivors have been followed up for 1 to 45 months during which period 3 deaths occurred, on at the 2nd month due to cardiac failure and 2 sudden deaths at the 5th and 22nd months. These 2 patients had not had recurrences of their arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗