PubMed Health⌕ Search

Biomedical subjects

P Vernant

Publications and source records attributed to P Vernant.

At least 19 recordsLinked to original sources
PubMed1991

[Coronary vascular reserve in heart transplantation. Normalization after therapy for rejection].

Acute rejection is associated with severe impairment of coronary reserve in heart transplants. To evaluate the effects of rejection therapy, coronary reserve was assessed in 6 patients before and after treatment of an acute episode of rejection. Coronary reserve was significantly enhanced after rejection therapy (4.7 +/- 0.8, vs 2.3 +/- 0.5, P less than 0.001) and was not significantly different from that of transplanted patients without rejection (5.4 +/- 0.8). This study provides evidence that alterations of coronary reserve due to acute rejection are reversible after treatment of the rejection episode.

Acute Disease↗
PubMed1991

[Valvotomy and congenital aortic valve stenosis. Long-term results].

Twenty nine patients (average age 11 years) underwent valvotomy for congenital valvular aortic stenosis from 1967 to 1983. The medium and long-term results were analysed retrospectively: 14 children have been reoperated; 11 for restenosis and 3 for aortic regurgitation after an average period of 11 years. Thirteen of the other 15 patients have been regularly followed-up for about 10 years: there are 7 good results, 3 average results and 3 restenoses. One patient was lost to follow-up after 9 years and the other patient died secondarily of a non-cardiac cause. This series was compared to a previous one of 35 cases of valvular aortic stenosis who underwent valvotomy between 1954 and 1964. There were 6 deaths in the perioperative period and 6 during follow-up (on average 11 years after surgery), including 3 sudden deaths. Eleven patients were reoperated: 2 for endocarditis, 5 for restenosis and 4 for aortic regurgitation (on average after 13 years). Three patients were lost to follow-up and there are 9 survivors who have not been reoperated (average follow-up 27 years): 5 of these patients were reexamined; there were 2 excellent results, 2 average results and 1 restenosis. These results show that conservative surgery of congenital valvular aortic stenosis is now a low risk procedure in children, but it is a palliative solution. The main problem is that of follow-up to detect restenosis because of the risk of sudden death. This follow-up is much easier since the introduction of Doppler echocardiography, eventually associated with exercise stress testing in doubtful cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Recovery of a normal coronary vascular reserve after rejection therapy in acute human cardiac allograft rejection.

During acute rejection, coronary vascular reserve is severely impaired in human orthotopic heart transplants. To evaluate the effects of rejection therapy on coronary vascular reserve, the ratio of peak-to-resting coronary flow velocity was assessed with a coronary Doppler catheter and a maximally vasodilating dose of intracoronary papaverine (12 mg) in nine allograft recipients without rejection (group 1) and in six recipients before and after treatment of an acute episode of rejection (group 2). All the patients had normal epicardial coronary arteries and were free of left ventricular hypertrophy. In group 2 during rejection, the coronary vascular reserve was significantly lower than in group 1, in which all the patients had a peak-to-resting coronary flow velocity ratio greater than 4 (2.3 +/- 0.5 vs. 5.4 +/- 0.8, respectively, p less than 0.001). In group 2 after treatment of rejection, the peak-to-resting coronary flow velocity ratio was similar to that of group 1 (4.7 +/- 0.8). Heart rate, left ventricular volumes and pressures, hemoglobin concentration, and arterial oxygen pressure were similar in the two groups. This study provides evidence that alterations of coronary vascular reserve because of acute rejection were reversible after treatment of the rejection episode.

Angiography↗
PubMed1990

[Dipyridamole echocardiography test during the acute phase of lower myocardial infarction].

Two-dimensional echocardiography with intravenous injection of dipyridamole (0.56 mg/kg) was performed in 33 consecutive patients with acute (2 +/- 2 days) postero-inferior myocardial infarction for semiquantitative segmental wall motion analysis. The results were compared with those of coronary angiography which was carried out during the hospital period. After a second evaluation of the recordings the following results were obtained: feasibility: 94 per cent with 85 per cent of segments analysed. Residual ischaemia in the first days of myocardial necrosis was common (70%). The ischaemia was often clinically silent including during the investigation (61%). When pain occurred, it always followed changes in regional wall motion. The dipyridamole test suggested multivessel disease with a sensitivity of 72 per cent and a specificity of 90 per cent, and residual arterial stenosis with a sensitivity of 75 per cent ans specificity of 80 per cent the secondary effects were minor. The main limitation of the test is related to the distinction between pharmacological and physiologic ischaemia. A positive test was associated with lesions justifying myocardial revascularisation (coronary bypass or angioplasty) in 19 out of 23 cases but with a very poor correlation with the topography of the coronary lesions. A negative test indicated arterial occlusion, residual stenosis with extensive myocardial damage or a normal coronary angiogram. Therefore, the dipyridamole echocardiography test may help identify a group of patients with little or no myocardial ischaemia in whom invasive investigations could be deferred; these patients contrast with the group with a positive test indicating residual ischaemia in which the coronary lesions should be documented by coronary angiography.

Aged↗
PubMed1979

[Aneurysm of the membranous septum, left ventricular-right atrial communication and arrhythmias].

An aneurysm of the membranous part of the interventricular septum associated with a complex congenital malformation of the endocardial cushions was diagnosed in a 39 year old woman who presented with syncope. Diagnosis was made by echocardiography and confirmed by angiography. The operative findings were: a double aneurysm of the membranous septum, a left ventricular--right atrial fistula and two hemivalves attached to papillary muscles. The usfulness of echocardiography in the diagnosis of aneurysm of the membranous interventricular septum and in the follow up of ventricular septal defects from which they arise is emphasised. The pathogenesis of the arrhythmias observed (accelerated idioventricular rhythm, reciprocating tachycardias and syncope possibly related to transient heart block) is discussed.

Adult↗
PubMed1979

[Computerized axial tomography in diagnosis of congenital heart diseases. Preliminary report].

Transverse sections of the heart and great vessels may be obtained by tomodensitometry using an exposure time short enough to carry out the investigation during apnoea, and an infusion of contrast medium. The definition is good enough for the investigation to be considered as a useful adjunct to the normal investigations in complex congenital cardiac abnormalities. All measurements are instantaneous, including the study of pulmonary density which allows assessment of the pulmonary vascularisation.

Adolescent↗
PubMed1979

[Arterial pressure during exertion in patients operated on for aortic coarctation].

19 patients were studied after operation for coarctation of the aorta. The average age at operation was 13.7 years. Crafoord's operation was performed in 16 cases and in the other three an aortic patch was necessary. The average post-operative period was 4.7 years. 14 cases were classified as good results: normal femoral pulses and arterial blood pressure. The other 5 cases were considered as unsatisfactory: 2 mediocre results with normal arterial blood pressure but diminished femoral pulses and oscillometric indices; 3 poor results with hypertension at rest. On exercise with bicycle ergometry the following results were obtained: the systolic blood pressure rose in a comparable manner to that observed in normotensive individuals of the same age on exercise except in 2 cases. These two patients had an aortic patch and one had a residual intraaortic pressure gradient. The pronostic significance of these findings is not known. However the use of an aortic patch is often associated with abnormal blood pressures at rest or on exercise. The fact that the majority of patients operated for coarctation of the aorta have normal blood pressure profiles on exercise should be emphasised.

Adolescent↗
PubMed1979

[Aortocoronary bypass permeability explored by tomodensitometry. Preliminary study].

The patency of 24 aorto-coronary grafts was studied by tomodensitometry. --16 out of the 18 bypasses examined within the two weeks following surgery were seen. --4 older bypasses were not visible, either by scanner or by angiography and were therefore occluded: two more, performed more than a year previously, were patent on tomodensitometric examination. The interpretation of the results, discussed taking into account the small number of angiographic check ups does not permit any formal conclusion as to the validity of the procedure. The results of this technique seem satisfactory and quite comparable with other non invasive methods used in the study of aorto-coronary grafts.

Adult↗
PubMed1979

[Acute mitral incompetence of ischemic origin (author's transl)].

Clinical findings and results of treatment in 17 patients with acute mitral incompetence are described. The lesions were secondary to a recent myocardial necrosis causing severe cardiac failure (shock, or acute left ventricular failure), and the presence of mitral incompetence was confirmed by right catherization (15 cases) and/or left ventricular angiography (13 cases). The anatomical lesions are described in 14 cases: rupture of the posterior mitral papillary muscle in 7 cases, and acute dysfunction of the muscle in 7 other cases. Eight patients were treated by an intra-aortic balloon to assist circulation, and 14 were given vasodilators (phentolamine, trinitrin) associated in 5 cases with positive inotropic drugs. Surgical treatment was given (mitral valve replacement) in 7 cases. The respective effects of vasodilators and circulatory assistance are discussed, as well as the indications for, and results of urgent surgical treatment (6 successes in 7 operations).

Acute Disease↗
PubMed1978

[Dwarfism and constrictive pericarditis. Apropos of a case of so-called Mulibrey dwarfism with hypereosinophilia].

A child of 10 was admitted to a cardiology unit with adiastole. The marked degree of dwarfism and anatomical features were characteristic of the so-called 'Mulibrey' dwarfism. Surgical intervention confirmed the constrictive pericarditis which is normally found in this condition. Unfortunately, the adiastole persisted which, taking into account the marked eosinophilia, made an associated endomyocardial fibrosis seem likely. The distinctive features of constrictive pericarditis and of the constrictive type of cardiomyopathy are recalled.

Cardiomyopathies↗
PubMed1978

[Vasodilator treatment of the acute phase of myocardial infarct with phentolamine. Analysis of hemodynamic results and therapeutic indications].

Treatment by phentolamine was carried out in 30 patients presenting with an acute myocardial infarction complicated by left ventricular failure, 8 of which had cardiogenic shock. The response to treatment was closely related to the level of overload of the left ventricle. Significant improvement in the haemodynamic state was only observed in the most severe cases of cardiac failure, and in these cases was accompanied by only a minimal and insignificant change in mean arterial pressure and heart rate.

Acute Disease↗
PubMed1978

[Severe tricuspid insufficiency and primary carcinoid tumor of the ovary. Long term success after valve replacement. Apropos of a case].

The case is reported of carcinoid heart disease in a lady of 70 with intractable congestive cardiac failure 5 years after the removal of a primary carcinoid tumour of the ovary. The special features of primary carcinoid tumours of the ovary are recalled, with emphasis on their rarity and of the absence of liver metastases. The various features of carcinoid syndrome are recalled in the light of current knowledge of the pathogenesis. A review of the literature on cardiac involvement in primary carcinoid tumours of the ovary, amounting to 10 cases, is included. The possibility of surgical cure of the heart lesions in carcinoid tumour by a prosthetic tricuspid valve are discussed, in the light of the 6 reported cases and the present one. Our report is the first one of replacement of the valve after removal of a primary ovarien carcinoid tumour, and the excellent result has been maintained after three years.

Aged↗