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Biomedical subjects

P Pouard

Publications and source records attributed to P Pouard.

23 records · Page 2Linked to original sources
PubMed1990

[Enoximone and pediatric heart surgery].

The double mode of action of enoximone, inotropic and vasodilator, makes it a valuable drug in adult cardiac surgery. There have been no reports of its use in paediatric cardiac surgery. We studied its effects in 15 children with a right heart malformation, 5 with cardiac transplants and 5 with various malformations of different complexity. Enoximone was administered as an IV bolus of 1 mg/kg over 10 minutes, relayed by a continuous infusion of 7.5 gamma/kg/mn. This drug was used alone in 15 patients and in association with dobutamine or dopamine in the others. Enoximone was associated with an improved haemodynamic status after repair of right heart malformations related to better left ventricular contractility, a moderate but statistically significant elevation of mean blood pressure without tachycardia, and stable right heart filling pressures. Improved systemic perfusion was also observed in children awaiting cardiac transplantation. This treatment provided a bridge to cardiac transplantation which was attained in good condition, given the difficulties of using mechanical circulatory assistance in children and the scarcity of donors. When associated with other pulmonary vasodilators, enoximone was effective in the treatment of right heart failure with pulmonary hypertension. When used alone or in association with catecholamines, enoximone is a treatment of choice in per and postoperative paediatric intensive care, especially as the synergist effect obtained enables a reduction in the quantity of classical inotropic agents used, thereby contributing to an attenuation of the phenomenon of exhaustion observed with catecholergic drugs.

Adolescent↗
PubMed1990

Primary repair of tetralogy of Fallot in infancy.

From June 1983 to April 1988, 100 consecutive infants with symptomatic tetralogy of Fallot (without pulmonary atresia) were operated on. Ages ranged from 0.5 to 12 months (mean 7.3 +/- 3.7). Twenty patients were 0.5 to 3 months, 21 were 3 to 6 months, and 59 were 6 to 12 months of age. Mean weight was 6.5 kg +/- 1.7. Seventy patients received a transannular patch. The hospital mortality rate was 3% and there were no late deaths. Cumulative follow-up was 180 patient-years. Causes of death included hypoplastic pulmonary arteries (4 and 5 months old) and right ventricular failure (4 months old). The most important factors influencing right ventricular outflow tract reconstruction were neither weight (p = 0.90) nor age (p = 0.05) but rather were the ratio between weight and pulmonary arterial outflow tract diameter (p = 0.0005) and the ratio between body surface area and pulmonary arterial outflow tract diameter (p less than 0.0001). The last 48 patients were operated on with no deaths. During this period, operative management differed essentially in myocardial protection with blood cardioplegia. The predicted 30-day survivorship after repair was 90% to 99% (95% confidence limits). No ventricular arrhythmias have been detected after repair (mean follow-up 22.2 months). Mean right ventricular/left ventricular end-diastolic dimension ratio was (0.53 +/- 0.10 with M-mode echocardiography. These early results encourage us to proceed with primary repair of infants with symptomatic tetralogy of Fallot thanks to improved surgical management and enhanced myocardial protection.

Blood Pressure↗
PubMed1989

Heart- and heart-lung transplantation in children.

Since January 1987, 16 prepubertal children have undergone heart (13) or heart-lung (3) transplantation. Immunosuppression included cyclosporine and azathioprine and excluded steroids except in case of rejection. The indications for heart transplantation were hypoplastic left heart syndrome (4 infants, mean age = 2 months), congenital heart disease (4 patients, mean age = 5.7 years) and cardiomyopathy (5 patients, mean age = 2.8 years). There were 4 early deaths (acute graft failure in 2, pulmonary hypertension in 1, infection in 1) and 1 late death (heart failure at 3 months). The 8 survivors had a mean follow-up of 12 months (range 1-19 months). Late complications were minimal. There were 4 episodes of rejection in 2 patients. There was no infection, normal somatic growth and no systemic hypertension. Renal function remained within normal limits although mild-to-moderate tubulointerstitial lesions were found in 4 renal biopsies. Three children (9-11 years old) underwent heart-lung transplantation. The early postoperative course was difficult with 6 episodes of rejection and 5 infections. One patient died at 3 months from infectious complications. One child has a complete rehabilitation 8 months posttransplantation. The last patient is clinically well at 7 months but has a residual tracheal stenosis. The long-term fate of these children, and particularly the long-term effects of cyclosporine therapy are unknown. Heart and heart-lung transplantation remain under investigation but may be reasonable approaches for infants and children with end-stage cardiac and/or pulmonary disease.

Acute Kidney Injury↗
PubMed1984

[Sodium nitroprusside in hypothermic surgery under extracorporeal circulation].

Sodium nitroprusside (SNP) is a vasodilator widely used in heart surgery. Its effects before and after bypass at normal temperature have been reported. This prospective study compares 15 patients who received SNP with 5 controls. SNP's efficacy on the systemic arterial resistance index is demonstrated during cooling and rewarming. Vasoconstriction at the end of persistent hypothermia does not respond to SNP. No signs of toxicity, neither biological (metabolic acidosis) nor clinical (respiratory or cardiac problems) were observed. SNP lowers pulmonary artery resistance index during normothermia and pulsed cardiac output, but a rebound appears 45 minutes after SNP withdrawal. SNP is usefull for anaesthesia in heart surgery with hypothermia.

Adult↗