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Biomedical subjects

Philippe Asseman

Publications and source records attributed to Philippe Asseman.

12 recordsLinked to original sources
PubMed2007

Low-level exercise echocardiography fails to elicit left ventricular contractile reserve in patients with aortic stenosis, reduced ejection fraction, and low transvalvular gradient.

BACKGROUND: Low-level exercise echocardiography is useful to assess left ventricular (LV) contractile reserve after an acute myocardial infarction. Whether low-level exercise can elicit LV contractile reserve in patients with severe aortic stenosis, reduced LV systolic function and low transvalvular gradient are unknown. Accordingly, the value of low-level exercise to elicit contractile reserve was assessed in these patients using dobutamine administration as the gold standard method. METHODS AND RESULTS: Seventeen patients with severely decreased aortic valve area (0.75 +/- 0.03 cm(2)), reduced LV ejection fraction (35 +/- 2%) and low mean transvalvular gradient (23 +/- 3 mmHg) underwent low-level exercise and dobutamine echocardiography. Ejection fraction increased by 23% (P < 0.001) with dobutamine and decreased by 8% (P = 0.2) with low-level exercise. Left ventricular outflow tract velocity time integral increased from 13 +/- 1 to 16.7 +/- 1 cm (P < 0.001) with dobutamine but did not change with low-level exercise (13 +/- 1 vs. 13.5 +/- 1, P = 0.5). CONCLUSION: Low-level exercise fails to elicit LV contractile reserve in patients with severe aortic stenosis, reduced LV systolic function, and low transvalvular gradient.

Aged↗
PubMed2006

Hemidiaphragmatic paralysis: an underestimated etiology of right-to-left shunt through patent foramen ovale?

OBJECTIVE: To report a specific pathophysiology of hemidiaphragmatic paralysis that may result in severe hypoxemia. DESIGN: Case series. SETTING: Intensive care unit in a cardiology hospital. PATIENTS: The series included three patients with refractory hypoxemia in whom a diagnosis of right-to-left-shunt through a patent foramen ovale was made by contrast echocardiography. The three patients had a complete right hemidiaphragmatic paralysis. INTERVENTION: Permanent percutaneous closure of the patent foramen ovale was successfully proceeded in all cases. MAIN RESULT: These procedures resulted in complete normalization of arterial oxygen saturation. CONCLUSION: To our knowledge, only three previous reports have described the association of right-to-left shunt through a patent foramen ovale and hemidiaphragmatic paralysis. Such association may be underestimated.

Aged↗
PubMed2006

Momentarily stuck in the foramen ovale.

An 80-year-old woman was admitted for a diagnosis of severe pulmonary embolism. A large serpentine thrombus stuck in a patent foramen ovale (PFO) completely resolved without the patient experiencing any manifestation. The right renal artery was the final destination. Thromboaspiration was unsuccessful. Three months later, the patient was diagnosed with a malignant melanoma and metastatic dissemination.

Aged, 80 and over↗
PubMed2006

Acute coronary syndromes associated with thrombus in the sinus of valsalva and normal coronary arteriography: the pivotal role of transesophageal echocardiography in the intensive care unit.

We describe 4 patients with thrombus in nonaneurysmal sinus of Valsalva. The diagnosis was made with transesophageal echocardiography performed in the Intensive care unit, in the setting of acute coronary syndromes. Coronary arterlography showed normal coronary arteries in each patient. In 3 patients, conservative medical therapy resulted in full recovery. Two patients had previously undergone aortic valve surgery.

Adult↗
PubMed2005

Myocardial asynchronism is a determinant of changes in functional mitral regurgitation severity during dynamic exercise in patients with chronic heart failure due to severe left ventricular systolic dysfunction.

AIMS: Functional mitral regurgitation (MR) and myocardial asynchronism occur commonly in patients with dilated cardiomyopathy and affect adversely their prognosis and symptoms. The aim of this study was to evaluate the mechanisms of changes in MR severity during dynamic exercise in patients with chronic heart failure (CHF). METHODS AND RESULTS: Seventy patients with CHF due to left ventricular (LV) systolic dysfunction [LV ejection fraction (EF) <40%] and functional MR were studied. All were in sinus rhythm. Medications were left unchanged for the study. Each patient performed a maximal symptom-limited exercise test with continuous 2D-Doppler echocardiography. Mitral regurgitant volume (RV) and effective regurgitant orifice (ERO) were determined at rest and during exercise. LV asynchrony using Doppler tissue imaging and interventricular asynchrony using conventional pulsed-Doppler were evaluated at rest. Resting LV EF averaged 25+/-8%. Mean resting LV and interventricular mechanical delays were 56+/-50 and 43+/-37 ms, respectively. The overall median values for mitral ERO and RV did not significantly change during dynamic exercise (11 [7-16] vs. 11 [6-21] mm2 and 14 [10-22] vs. 12 [9-23] mL, respectively). However, changes in mitral ERO and RV were individually variable and significantly correlated with the degree of LV asynchronism (r=0.66, P<0.0001 and r=0.66, P<0.0001, respectively). CONCLUSION: Changes in MR are variable during dynamic exercise. LV asynchronism at rest substantially contributes to worsening of functional MR during dynamic exercise in patients with CHF due to LV systolic dysfunction.

Aged↗
PubMed2005

Dissociation between improvement in left ventricular performance and functional class in patients with chronic heart failure.

Resting left ventricular ejection fraction (LVEF) and functional capacity do not correlate in chronic heart failure patients treated with digitalis, diuretics, and angiotensin-converting enzyme inhibitors. We sought to determine whether substantial improvement in LVEF, as may occur during long-term beta-blockade or after coronary artery bypass graft (CABG) surgery, leads consistently to improvement in functional class. Doppler echocardiogram and assessment of functional class were obtained at baseline and 12 months after initiation of beta-blockade (87 patients) or CABG surgery (51 patients). At 12 months the effects of beta-blockade were variable: LVEF increased greatly by >or=11% (median value) in 45 patients (52%) and by <11% in 19 (22%), but it decreased or remained unchanged in 23 patients (26%). In contrast, functional class was unchanged or worsened in 59 patients (68%) and improved in only 28 (32%). Similarly, surgery had variable effects on LVEF. LVEF increased by >or=12% (median) in 28 patients (55%) and by <12% in 14 (27%), whereas it decreased or remained unchanged in 9 patients (18%). Functional class was unchanged or worsened in 41 patients (80%) and improved in only 10 (20%). Changes in functional class and LVEF were unrelated for both interventions. Both beta-blockade and CABG surgery improve LVEF in the majority of patients. However, significant improvement in LVEF does not enhance functional capacity consistently in chronic heart failure.

Adrenergic beta-Antagonists↗
PubMed2005

Transient left ventricular basal dysfunction without coronary stenosis in acute cerebral disorders: a novel heart syndrome (inverted Takotsubo).

Myocardial dysfunction without coronary involvement may occur in acute cerebral diseases. We report 4 cases where, in the context of acute cerebral disorder, the echocardiograms revealed an extensive left ventricular circumferential akinesis except at the apex. Besides, for three of those cases no coronary disease has been highlighted. Recognition of such a pattern of LV dysfunction should lead to the search for an acute cerebral disease.

Acute Disease↗
PubMed2003

Relationship of intimal flap position to endovascular treatment of malperfusion syndromes in aortic dissection.

PURPOSE: To propose a classification system based on the position and extension of the intimal flap to assist in the endovascular repair of aortic dissection complicated by a malperfusion syndrome. METHODS: Forty-one patients (34 men; mean age 58 years, range 22-78) with 19 type A and 22 type B dissections complicated by a malperfusion syndrome were treated with stenting, fenestration, or both for the peripheral ischemia. A retrospective review of the preprocedural imaging studies (computed tomographic angiography and arteriography) was performed to determine and categorize the position of the aortic intimal flap. In type 1, the flap was either parallel to or perpendicular to the origin of the malperfused collateral artery; type 2 referred to extension of the dissection into the collateral vessel, while type 3 represented the presence or absence of an avulsed branch ostium. RESULTS: Patients treated with stenting (n=19) alone had type 2 or type 3 arterial dissections, whereas the 12 patients who were treated with fenestration alone had type 1 lesions. Ten patients treated with stenting and fenestration had arterial lesions in which a type 1 dissection was associated with types 2 or 3. CONCLUSIONS: This appearance-based imaging approach combined with the symptoms of malperfusion syndromes during aortic dissection can help guide the endovascular treatment strategy.

Adult↗
PubMedDate not supplied

[What is the place of beta-adrenergic blockade therapy in coronary syndromes in the modern management era?].

This paper shows the eventual benefits of treatment with beta-blockers in post-myocardial infarction. An overview of main clinical trials that have been conducted to test this therapeutic in acute coronary syndrome. In patients presenting with acute myocardial infarction, the early use of intravenous beta-blockers had shown a modest and non significant reduction in mortality. Substantial reductions in mortality and reinfarction have been demonstrated when beta-blockers have been used soon after an acute myocardial infarction and continued long-term. However, these benefits were observed in randomised clinical trials conducted in the 1970s and 1980s, prior to the widespread use of reperfusion therapies and antiplatelet agents. It appears obvious that the long-term use of beta-blockers may be questionable after any acute coronary syndrome especially if complete reperfusion has been achieved and left ventricular function is preserved.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

[Is there a role for calcium antagonists when beta-adrenergic blockade therapy is contraindicated in post-myocardial infarction?].

The purpose of this paper is to examine the eventual benefits of treatment with calcium channel blockers in post-myocardial infarction, through an overview of main placebo-controlled trials that have been conducted to test this therapeutic in acute coronary syndromes. It appears obvious that the vast majority of these trials was conducted in the pre-reperfusion era and failed to demonstrate a reduction in mortality. To conclude, the superiority of a therapy with calcium antagonists over a placebo in the management of post-myocardial infarction remains unknown. In contrast, adverse effects associated with the prescription of calcium antagonists are well known.

Adrenergic beta-Antagonists↗