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Biomedical subjects

R Kieny

Publications and source records attributed to R Kieny.

At least 19 recordsLinked to original sources
PubMed1992

[Transesophageal echography and peripheral arterial embolism. A new etiologic approach. Apropos of 87 cases].

This prospective study (September 1989 to November 1990) was undertaken to evaluate the utility of transesophageal echocardiography in acute peripheral ischaemic syndromes. After embolectomy or thrombolysis, 87 patients with an average age of 69.7 years underwent not only the usual investigations (conventional echocardiography, abdominal ultrasonography and Holter monitoring) but also transesophageal echocardiography within 2 days of the ischaemic events (lower limb 84%, multiple embolism 11%, recurrent embolism 13%). Atrial fibrillation was documented in 44 patients (50.5%), 19 patients had chronic arterial disease (22%), 8 patients had valvular heart disease (9%) and 2 patients had a blood disorder (2%). Transthoracic echocardiography only demonstrated one left ventricular apical thrombus whereas transesophageal echocardiography showed residual thrombus in 22 patients (25%) mainly in the left auricle but also in the descending thoracic aorta (8 patients) as a mobile, pediculated thrombus or lining an aortic aneurysm, thereby opening up new therapeutic possibilities. In addition, double aortic dissection was diagnosed in a patient who was not echogenic, isolated spontaneous contrast in 20 patients (23%) and other abnormalities in 7 patients (8%). Statistical analysis showed a significant relationship between the presence of thrombus and/or spontaneous contrast in the left atrium and/or left auricle and the size of the left atrium (Fisher test - p = 0.0073), and the presence of a supraventricular arrhythmia (chi 2 test).

Adult↗
PubMed1991

[Surgery of gastrointestinal vessels, selective indications for revascularization in a syndrome suggestive of chronic small intestinal ischemia].

The authors present a critical review of the indications for revascularization of intestinal arteries in the presence of chronic ischaemia of the small intestine. They stress the extreme lability of the "chronic" clinical stage and emphasize the fundamental importance of establishing the diagnosis before the development of acute complications. Based on a personal experience of 92 intestinal revascularizations with a follow-up of one to 26 years, they stress the good quality of the results obtained after isolated revascularization of the superior mesenteric artery by direct or indirect reimplantation into the infrarenal aorta. However, they do not challenge the current tendency towards multiple revascularizations, but consider that the essential prerequisite for a correct result is the early surgical treatment of a disease which is still poorly understood and frequently disappointing.

Arteriosclerosis↗
PubMed1990

Percutaneous atherectomy with the Kensey catheter: early and midterm results in femoropopliteal occlusions unsuitable for conventional angioplasty.

Forty-six femoropopliteal occlusions in 44 patients (aged 45-95 years) were recanalized with the percutaneous rotating tip atherectomy catheter completed by balloon dilatation. Thirty-one patients had tight intermittent claudication of the lower limbs, five had resting pain and 10 had skin disorders. The length of the occlusion ranged from 2 to 24 cm. Of 46 procedures, 40 (87%) were immediately successful (increase of mean Doppler systolic ankle-arm index from 0.44 to 0.89) and six (13%) were failures. In two it was impossible to pass through the lesion and in four arterial perforation occurred without any clinical consequences. Of the six failures, five occurred in calcified arteries. Five recanalizations (11%) reoccluded within 48 hours, bringing the total number of early failures to 11. Of these 11 failures, nine were treated by femoropopliteal vein bypass and two by medical treatment only. Two postoperative asymptomatic posterior tibial artery embolisms were treated medically, and one popliteal artery embolism was treated using a Fogarty catheter. At the present time, 25 of 35 primary successes had been followed for six months, and 20 for 12 months with primary patencies 18 of 25 (72%) and 14 of 20 (70%), respectively. If massively calcified lesions are excluded, femoropopliteal recanalization with the percutaneous rotary Kensey atherectomy catheter followed by balloon catheter dilatation is efficacious and reliable with an 80% primary success rate and a 70% patency rate at one year.

Aged↗
PubMed1990

[Surgical therapy of acute mesenteric artery occlusion].

Only early diagnosis and vascular surgery during the period of ischemic tolerance (about 12 hours) will improve the results of treatment of acute splanchnic artery occlusion. From 1966 to 1989, 98 patients were treated: 81 underwent operations (65 emboli of the SMA, 16 arteriosclerotic obstructions). Of the 47 patients who were treated at the stage of reversible acute mesenteric ischaemia 12 died (25.5%). Of the 34 patients undergoing surgery at the stage of small bowel infarction 24 died postoperatively (70.6%).

Adult↗
PubMed1990

[Is Trendelenburg's procedure still useful in 1990? Apropos of 3 cases of massive pulmonary embolism surgically treated successfully in a general surgery department].

The authors report about 3 cases of massive pulmonary embolism operated successfully in a context of general surgery. As they discuss the data given by the literature, they establish the remaining indications of Trendelenburg's procedure, as well as the problems encountered today to perform it without the help of extracorporeal circulation.

Emergencies↗
PubMed1990

[Peripheral arterial recanalization using a Kensey catheter].

Between June 6 1988 and September 30 1989, 46 superficial femoral obliterations in 44 patients were treated by rotary atherectomy, completed by conventional dilatation in 40 patients. The 44 patients (27 males and 17 females), mean age over 66.5 years (45 to 90), presented symptomatic superficial femoral obliterations (17 tight stage, two occlusions, 5 stage III, and 10 stage IV occlusions), with mean length of 9.8 cm (2 to 24 cm). Vascular echography was performed systematically before the procedure, to assess the extent of intraluminal calcification. Moreover, a control venous angiography was performed on the third day. Of the 46 treated arteries, the occlusions which had remained impermeable with a traditional guidewire were traversed successfully and without incident in 40 cases (87%). In case 20, the massively calcified obliteration could not be traversed, and perforation occurred in four cases, but without clinical consequences. In five other cases (11%), precocious reocclusion occurred before the 48th hour. It should be pointed out that, in 2 of these 5 cases, no additional conventional dilatation had been performed at the beginning of the trial. In 35 cases (76%), satisfactory permeability with residual stenosis less than 30% was thus obtained upon discharge from the hospital. For these patients, the lower limb/upper limb Doppler index rose from 0.44 to a mean 0.89 after treatment. 2 embolism were observed: one popliteal treated by embolectomy. The mid term permeability at 6 months is 80% among the 25 primary successes.

Aged↗
PubMed1979

[Real-time cross-sectional echocardiography. Application in the measurement of the surface area of the mitral orifice in cases of stenosis or of double involvement of the valve (author's transl)].

Two-dimensional echocardiography in real time has proved in recent years to be a very valuable means of investigation in cardiology, in particular in the area of valve disease and congenital cardiac malformations. The present study concerns a group of 20 patients with essentially stenosing mitral disease, studied by two-dimensional echocardiography using mechanical sector scanner. The authors report their experience of the method in the measurement of the surface area of the mitral orifice from echotomographic sections obtained in protodiastole in a plane perpendicular to the long axis of the left ventricle and passing through the free edge of the mitral cusps. Fifteen of these patients being then treated by valve replacement, the area measured were compared with those found in the operative specimens. In 14 cases out of 15 (93%), despite the concomitant existence of appreciable mitral incompetence in 9 cases out of 15, the surface areas did not differ by more than 0.23 cm2 (coefficient of correlation = 0.990). These results confirmed that two-dimensional echocardiography in real time is a reliable method for the direct measurement of the mitral orifice area in the presence of stenotic type disease of the valve and even in the presence of associated mitral regurgitation.

Adult↗
PubMed1979

[Problems encountered by the anesthetist-intensive care specialist during aorto-coronary bypass surgery].

The authors studied a series of 288 patients undergoing surgery for aorto-coronary bypass. The anaesthetic protocol and operative protocol are described and particular emphasis is placed upon the aortic clamp time. Mortality and peri-operative complications are then analysed. The treatment of such complications is based essentially upon vasodilators and where necessary intra-aortic counter-pressure balloon device to provide circulatory assistance.

Anesthesia↗
PubMed1979

[Congenital carotid to jugular aneurysm].

A congenital carotid--jugular aneurysm was responsible for severe heart failure in a two day old baby. The child recovered after surgery. The signs suggesting an arteriovenous fistula (a continuous murmur and thrill, hyperdynamic circulation) may be absent, as in this case, when the child is in severe cardiac failure. The signs should be sought when the circulation improves.

Arteriovenous Malformations↗
PubMed1978

[Distal fixation of the intima after endarterectomy. Technical variation].

Oblique termination in a "bevel" of the distal endartery and its fixation by a circumferential continuous suture which provides a surface which is as stable and regular as possible, after endarterectomy. This may favourise improuved distal flow and influence immediate and late local permeability.

Arteries↗
PubMed1978

[Surgical treatment of massive pulmonary embolism. (Reported of 45 successful embolectomies inclusive 10 with Trendelenburg's technic) (author's transl)].

45 pulmonary embolectomies have been carried out successfully, 10 by Trendelenburg's procedure, 35 with extracorporeal circulation. The latter method gives satisfactory results (34 survivals out of 36 attempts since 1970) and appears to be the procedure of choice. Any pulmonary trauma should be avoided at operation; embolectomy is done by intra-vascular suction. The hemodynamic status was always abnormal: 5 initial cardiac arrests, 20 cases of severe shock (9 demonstrating cardiac arrest on the operating table) and 11 cases with less severe shock. In 9 cases cyanosis, respiratory distress and signs of acute cor pulmonale were the clinical features of the massive embolus. In 9 patients the operation was performed after an unsuccessful trial of thrombolysis. Preoperative pulmonary angiography could be performed in 30 cases and always showed extensive pulmonary vascular obstruction of 60 to 95 per cent. These data are important for diagnosis and for assessment of the prognosis. Despite of present medical treatment with fibrinolytics, surgery is still advisable in the treatment of massive pulmonary embolism. The indications are moribund patients, those in whom thrombolysis is contraindicated or unsuccessful and those with massive pulmonary obstruction (greater than 60 per cent). In this latter subset thrombolytic therapy carries a high level of mortality.

Clot Retraction↗
PubMed1978

[A treatable condition: parietal rupture of the heart during the acute phase of myocardial infarct. Apropos of a further case treated successfully with surgery].

A man aged 62 had an unexpected anterior myocardial infarction, complicated during the thirteenth hour after onset by parietal rupture and consequent acute tamponnade. The diagnosis was confirmed by echocardiography and then by pericardial puncture which allowed enough time for an operation to be undertaken under extra-corporeal circulation. The infarct was resected together with the weakened area of rupture, and the quality of the patient's life has been maintained at an excellent level after one year.

Cardiac Surgical Procedures↗
PubMed1978

[Early surgical treatment of a septal perforation complicating a posterior infarct. Value of the diaphragmatic left ventricular approach].

The authors report the case of a 53 year old patient who required operation on the 5th day after postero-inferior myocardical infarction for a poorly tolerated perforation of the ventricular septum. In discussing this case, they recall that the results for surgical repair of septal perforations complicating myocardial infarction are poorer when the infarction is posterior than when it is anterior. They suggest that this difference in prognosis is in large part due to the customary use in postero-inferior infarcts, of the right transventricular approach, which does not allow the infarct to be resected at the same time as the septum is closed. They finish by recommending the systematic use of a diaphragmatic approach to the left ventricle, including resection of the infarct, for all cases of septal perforations with posterior infarction in which surgery is necessary.

Cardiac Catheterization↗
PubMed1978

Anatomic, clinical, and therapeutic features of acute cardiac rupture. Successful surgical management fourteen hours after myocardial infarction.

A 62-year-old man sustained an acute myocardial infarction complicated on the thirteen hour by left ventricular rupture and acute periocardial tamponade. Echocardiography confirmed the suspicion of intrapericardial fluid, and immediate pericardiocentesis improved the hemodynamic state for a period sufficient to permit preparation for operation. Resection of ruptured and necrotic anteroapical left ventricular myocardium with primary reconstruction was successfully accomplished with the aid of temporary extracorporeal circulation. The patient has remained well for 1 year after the operation. Anatomic, clinical, and therapeutic features of acute cardiac rupture are discussed.

Cardiac Tamponade↗