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Raymond Roudaut

Publications and source records attributed to Raymond Roudaut.

32 records · Page 2Linked to original sources
PubMed2004

Clinical significance of early thrombosis after prosthetic mitral valve replacement: a postoperative monocentric study of 680 patients.

OBJECTIVES: The aim of this study was to evaluate the incidence of early thrombosis, its prognostic significance, and the therapeutic implications. BACKGROUND: Transesophageal echocardiography (TEE) is the method of choice for detecting symptomless early postoperative thrombosis of prosthetic valves. However, the clinical significance is not yet known. METHODS: Between June 1994 and December 2000, 680 consecutive patients underwent TEE on day 9 after mechanical mitral valve replacement, to search for early thrombosis. Initially, end points were the in-hospital outcome and treatment. Patients were also evaluated 34 +/- 22 months after surgery. RESULTS: Sixty-four early thrombi were detected (9.4%). Two early obstructive were treated by redo-surgery. Sixty-two nonobstructive benefited from medical treatment. The patients were allocated into two groups as a function of the maximum size of thrombus: <5 mm in 29 patients (group A) and > or =5 mm in 35 (group B). During early follow-up, we observed one complicated course in group A and eight in group B. In the long-term survey, three complications were noted in group A and 11 in group B. Incidence of early (p = 0.027) and long-term (p = 0.04) complications were significantly different in the two subsets. CONCLUSIONS: This study confirms the incidence of early thrombi after mechanical mitral valve replacement detected by TEE. A small (<5 mm) nonobstructive thrombus seems benign, and our experience argues in favor of medical treatment. Prognosis appears more serious for large thrombi. Medically aggressive therapy and further surgery should be considered in cases of obstructive thrombosis or large and mobile nonobstructive thrombosis.

Adult↗
PubMed2004

Improvement of left ventricular wall synchronization with multisite ventricular pacing in heart failure: a prospective study using Doppler tissue imaging.

UNLABELLED: We sought to assess right, left and biventricular pacing effects on myocardial function by using pulsed-Doppler tissue imaging (DTI) and automated border detection (ABD) techniques which provide electromechanical delay (EMD) assessment of the different left ventricular walls. METHODS: 15 patients (67+/-7 years) with drug-resistant primitive dilated cardiomyopathy and QRS> or =140 ms received a pacemaker for multisite ventricular pacing. Echocardiography was performed after 1 month of biventricular pacing (BVP). Echocardiographic measurements were recorded during spontaneous rhythm (SpR), right ventricular pacing (RVP), left ventricular pacing (LVP) and BVP. RESULTS: LV ejection fraction was statistically similar between the four rhythms. BVP showed a significant EMD decrease for the lateral LV wall vs. SpR, RVP and even LVP. LVP resulted in significantly longer aortic pre-ejection time vs. BVP while the EMD temporal dispersion (time between the shortest regional EMD and the longest one) was similar in the two modes. CONCLUSIONS: BVP and LVP substantially reduce the EMD temporal dispersion of the four LV walls, but with a longer aortic pre-ejection time for LVP. In RVP, LVP and BVP, the septal LV wall is always activated later than during SpR. BVP and LVP are associated with a mitral regurgitation reduction.

Aged↗
PubMed2004

Intra-left ventricular electromechanical asynchrony. A new independent predictor of severe cardiac events in heart failure patients.

OBJECTIVES: We sought to assess the electromechanical parameters, using tissue Doppler echocardiography, as potential independent predictors of heart failure (HF) worsening. BACKGROUND: Ventricular conduction disorders worsen the prognosis for HF patients. However, the relationships between the QRS width and morphology, hemodynamic parameters, and presence and magnitude of intra-left ventricular (LV) and inter-ventricular (V) asynchrony have not been well clarified. METHOD: A total of 104 patients with an LV ejection fraction (EF) </=45% and stabilized HF, without myocardial infarction (MI), underwent echocardiography coupled with tissue Doppler imaging and were followed for one year. The protocol analyzed the incidence of worsening HF (hospitalization for cardiac decompensation). Inter-V and regional electromechanical delays for the anterior, septal, inferior, and lateral LV walls were correlated with the QRS morphology and duration. The intra-LV and inter-V asynchrony values of these patients were compared with those of healthy subjects matched by gender and age criteria to determine the respective normal ranges. RESULTS: The presence of intra-LV (but not inter-V) asynchrony was identified as an independent predictor of severe cardiac events (hazard ratio 3.39, p < 0.0001), independent of the LVEF and QRS width. Of patients with a QRS width <120 ms (55%; n = 57), 56% presented with major intra-LV asynchrony and 12% with inter-V asynchrony. Intra-LV asynchrony was observed in 84% of left bundle branch block patients, but also in 83% of right bundle branch block patients (p = NS). There was a poor correlation between the QRS width and intra-LV or inter-V asynchrony (r = 0.36, p = NS and r = 0.43, p = 0.05, respectively). CONCLUSIONS: In HF patients without MI, patients with intra-LV asynchrony are those with a significantly higher risk of cardiac events, independent of the QRS width and LVEF. Accordingly, such patients should be more actively identified for early intensive treatment and survey.

Aged↗
PubMed2004

Transesophageal echocardiography improves risk assessment of thrombolysis of prosthetic valve thrombosis: results of the international PRO-TEE registry.

OBJECTIVES: The goal of this study was to evaluate whether quantitation of thrombus burden with transesophageal echocardiography (TEE) can help risk-stratify patients undergoing thrombolysis of prosthetic valve thrombosis (PVT). BACKGROUND: Thrombolytic therapy of PVT has an unpredictable risk of embolization and complications. METHODS: An international registry of patients with suspected PVT undergoing two-dimensional/Doppler and TEE before thrombolysis was established. All TEE studies were reviewed and quantitated by a single observer blinded to all data. RESULTS: From 1985 to 2001, 107 patients (71 females; age 24 to 86 years) from 14 centers (6 in the U.S.) were identified. The majority of cases involved the mitral valve (79 mitral, 13 aortic, and 15 tricuspid). Hemodynamic success rate was achieved in 85% and was similar across valves. Overall complications were observed in 17.8%, and death in 5.6%. Predictors of complications were: New York Heart Association (NYHA) functional class, presence of shock, sinus tachycardia, hypotension, previous history of stroke, thrombus extension beyond the valve ring, and thrombus area. Multivariate analysis demonstrated that two variables were independent predictors of complications: thrombus area by TEE (odds ratio [OR] 2.41 per 1 cm2 increment, 95% confidence interval [CI] 1.12 to 5.19) and prior history of stroke (OR 4.55, 95% CI 1.35 to 15.38). A thrombus area <0.8 cm2 identified patients at lower risk for complications from thrombolysis, irrespective of NYHA functional class. CONCLUSIONS: In PVT, the thrombus size imaged with TEE is a significant independent predictor of outcome. Transesophageal echocardiography can identify low-risk groups for thrombolysis irrespective of symptom severity and is therefore recommended in the management of prosthetic valve thrombosis.

Adult↗
PubMed2004

Biventricular pacing and left ventricular pacing in heart failure: similar hemodynamic improvement despite marked electromechanical differences.

INTRODUCTION: We conducted an acute echocardiographic study comparing hemodynamic and ventricular dyssynchrony parameters during left ventricular pacing (LVP) and biventricular pacing (BVP). We sought to clarify the mechanisms responsible for similar hemodynamic improvement despite differences in electrical activation. METHODS AND RESULTS: Thirty-three patients underwent echocardiography prior to implantation with a multisite pacing device (spontaneous rhythm [SR]) and 2 days after implantation (BVP and LVP). Interventricular dyssynchrony (pulsed-wave Doppler), extent of myocardium displaying delayed longitudinal contraction (%DLC; tissue tracking), and index of LV dyssynchrony (pulsed-wave tissue Doppler imaging) were assessed. Compared to SR, BVP and LVP caused similar significant improvement of cardiac output (LVP: 3.2 +/- 0.5, BVP: 3.1 +/- 0.7, SR: 2.3 +/- 0.6 L/min; P < 0.01) and mitral regurgitation (LVP: 25.1 +/- 10, BVP: 24.7 +/- 11, baseline: 37.9 +/- 14% jet area/left atria area; P < 0.01). LVP resulted in a smaller index of LV dyssynchrony than BVP (29 +/- 10 vs 34 +/- 14; P < 0.05). However, LVP exhibited a longer aortic preejection delay (220 +/- 34 vs 186 +/- 28 msec; P < 0.01), longer LV electromechanical delays (244.5 +/- 39 vs 209.5 +/- 47 msec; P < 0.05), greater interventricular dyssynchrony (56.6 +/- 18 vs 31.4 +/- 18; P < 0.01), and higher%DLC (40.1 +/- 08 vs 30.3 +/- 09; P < 0.05), leading to shorter LV filling time (387 +/- 54 vs 348 +/- 44 msec; P < 0.05) compared to BVP. CONCLUSION: Although LVP and BVP provide similar hemodynamic improvement, LVP results in more homogeneous but substantially delayed LV contraction, leading to shortened filling time and less reduction in postsystolic contraction. These data may influence the choice of individual optimal pacing configuration.

Aged↗
PubMed2003

Fibrinolysis of mechanical prosthetic valve thrombosis: a single-center study of 127 cases.

OBJECTIVES: This study was designed to analyze the results of fibrinolytic treatment (FT) in a large single-center group of patients with prosthetic heart valve thrombosis (PHVT). BACKGROUND: Fibrinolytic treatment of PHVT represents an alternative to surgery, but is still controversial because of the risk of embolism. METHODS: A total of 110 consecutive patients presenting with 127 instances of PHVT received FT between 1978 and 2001. The diagnosis of PHVT was established mainly by fluoroscopy and/or echocardiography. The first fibrinolytic agent used was streptokinase (SK) in 49 cases, urokinase (UK) in 41 cases, and recombinant tissue-type plasminogen activator (rtPA) in 37 cases. A second FT was consecutively infused in 38 patients (30%) and a third FT in 11 others. The efficacy of FT was assessed from hemodynamic parameters derived from echographic examinations as well as on clinical grounds. RESULTS: Complete resolution of hemodynamic abnormalities was seen in 90/127 patients, partial resolution in 22/127 patients, and no change in 15/127 patients after one or more consecutive fibrinolytic regimens. When SK or rtPA were used as the first fibrinolytic agent, they appeared significantly superior to UK in terms of valve reopening. Fifteen patients died. Severe hemorrhagic complications were observed in six patients. Nineteen documented embolic events occurred during FT. Finally, PHVT recurred in 24 patients, 17 of whom were retreated with lytic agents. CONCLUSIONS: These results indicate that FT is effective in most cases of PHVT, regardless of prosthesis or site involved. However, embolism, hemorrhage, and death were not uncommon after lytic therapy of left-sided PHVT, limiting its application to patients at high risk with alternative treatment.

Adolescent↗
PubMed2003

Surgery for prosthetic valve obstruction. A single center study of 136 patients.

OBJECTIVES: Prosthetic heart valve obstruction (PHVO) is a potentially fatal complication of heart valve replacement with mechanical substitute mainly due to thrombosis. The purpose of this report is to present a single-center experience of 136 consecutive patients operated on between 1978 and 2001. METHODS: The diagnosis of PHVO was mainly assessed by fluoroscopy and/or echocardiography. Thrombosed valves were bileaflet (82), tilting disc (47) and ball cage (7) valves; of these, 90 were in mitral, 38 in aortic, six in aortic and mitral position, and two in tricuspid position. The mean interval between the first implantation and valve thrombosis was 7.4+/-6.6 years (range 1 day to 28 years); in 37 patients preoperative medical therapy (fibrinolysis in 21, and heparin alone in 16) was unsuccessful. RESULTS: Operative procedures included valve re-replacement in 104 cases and declotting-pannus excision in 32 cases. Early hospital mortality was 10.3% (14 patients), all in NYHA class III or IV, and one patient suffered a perioperative cerebral embolic event. Surgery was then successful in 121 of 136 patients (89%), but during a 3.15-year follow-up, prosthetic heart valve thrombosis recurred in ten out of 122 survivors (8.1%). CONCLUSION: From this experience, it can be concluded that for most PHVO, early operation is currently effective and safe, especially in patients in stable hemodynamic condition preoperatively.

Adolescent↗
PubMed2002

Evaluation of cardiovascular risk factors in HIV-1 infected patients using carotid intima-media thickness measurement.

BACKGROUND: Highly active antiretroviral therapies (HAART) in HIV-infected patients are often associated with lipodystrophy syndrome and metabolic disorders. Atherogenic lipid profile could expose these patients to atheromatous cardiovascular disease. We describe carotid artery intima-media thickness (IMT), a surrogate marker of atherosclerosis, according to HIV status, antiretroviral treatment, lipodystrophy and conventional cardiovascular risk factors. METHOD: In a multicenter prospective cohort study we have surveyed HIV-infected subjects with a carotid IMT measurement by B-mode ultrasonography. We collected information on lipodystrophy clinical manifestations, age, gender, body mass index (BMI), smoking habits, alcohol intake, systolic blood pressure, HIV transmission category, AIDS stage, type and duration of HAART, CD4+ cell count, plasma HIV-1 RNA, glucose, insulin, total cholesterol and homocysteine. RESULTS: Four hundred and twenty-three HIV-infected patients were studied. The median carotid IMT measurement was 0.54 mm (range: 0.50-0.60). Lipodystrophy syndrome was diagnosed in 161 HIV-infected patients (38.1%). In univariate linear regression, IMT was significantly higher (P<0.05) with older age, male gender, higher body mass index, higher waist-to-hip ratio, increased systolic blood pressure, total cholesterol, glucose disorders and homocysteine, regular smoking and alcohol consumption, lipodystrophy and HAART. In a multivariate analysis, the effect of lipodystrophy and HAART disappeared after adjustment for other cardiovascular risk factors. CONCLUSIONS: It was concluded that only conventional cardiovascular risk factors are independently associated with increased IMT in HIV-infected patients.

Adult↗
PubMed1999

Acute Myocardial Infarction During Transesophageal Echocardiography.

We describe the occurrence of acute myocardial infarction during transesophageal echocardiography (TEE) in a patient with atrial fibrillation and underestimated angina. Such a case has not been previously reported in the literature. This case illustrates one of the possible complications of TEE, leading us to suggest systematic sedation in patients with angina in whom TEE is envisaged.

Journal Article↗
PubMed1998

Assessment of Left Ventricular Area at Risk by Myocardial Contrast Two-Dimensional Echocardiography: An Evaluation of a New Animal Model.

BACKGROUND: New echocardiographic contrast agents are commonly tested in the dog model. However, this species has a number of drawbacks, including difficulties in experimentation, cost, and ethical considerations. The rabbit has a number of advantages due to its relative simple coronary circulation. The present study was designed to evaluate the rabbit model for determination of areas of risk (ARs) by contrast echocardiography. METHODS: Eight rabbits were intubated and mechanically ventilated after occlusion of the left coronary artery with a ligature. The transducer (operating at 7.5 MHz) was positioned on the right ventricle through a right thoracotomy. The images were obtained after intra-aortic injection of 1 ml of Albunex, followed by 3 ml of dye (Blue Uniperse) for histological analysis postmortem. The ARs were obtained after circumscription of the various echocardiographic and histological images. RESULTS: Excellent echocardiographic images were obtained, largely due to the hemodynamic stability of the rabbit to ischemia. Echocardiographic ventricular areas, absolute AR, and relative AR correlated closely with postmortem data (r = 0.86, 0.94, and 0.94, respectively). The measurements were highly reproducible with low variability. CONCLUSIONS: The rabbit model shows promise for study by contrast echocardiography of myocardium subjected to ischemia. This method for determination of ARs was validated against postmortem findings. The method also should be of value in the evaluation of reperfusion.

Journal Article↗
PubMed1996

Significance of "Strands" on Mitral Mechanical Prostheses During Late Follow-Up After Surgery.

The presence of "strands" on mitral mechanical prostheses (MMP) has been described, although their significance has yet to be established. The aim of this study was to determine the incidence and clinical implications of "strands" on MMP in late follow-up by a retrospective analysis of 320 consecutive patients who had undergone a transesophageal echocardiographic (TEE) examination under standardized conditions 7 +/- 6 years after mitral surgery. Twenty patients (6.25%) with "strands," defined as highly mobile linear echogenic densities, were identified. This group was compared with a control group of 38 patients, matched for age, sex, and interval between surgery and TEE study, selected at random from this population. Patients with MMP dysfunction were excluded. Type of prosthesis, echographic characteristics (left atrial diameter, spontaneous echo contrast, ejection fraction), and anticoagulant status were not found to bear any relationship to the presence of strands. However, the prevalence of previous embolic events was significantly higher in the "strand" group (10/20 [50%]) than in the control group (7/38 [18.4%]) (P < 0.05). The "strand" group also contained more patients with a prior history of mitral prosthesis thrombosis (7/20 [35%] vs 1/30 [2.6%]; P < 0.05). However, long-term follow-up (1-4 years) was uneventful. These results suggest that: (1) in late follow-up, strands are rare in patients with MMP (6%); and (2) strands were related to previous thromboembolic episodes. (ECHOCARDIOGRAPHY, Volume 13, May 1996)

Journal Article↗
PubMed1996

Relationship Between Intravascular Hemolysis and Bright Sparkling Echoes Detected by TEE in the Vicinity of Mechanical Mitral Prosthesis.

The significance of abnormal bright and sparkling echoes in patients with mechanical mitral prosthetic valves (MMPV) has yet to be established. In the present study, the incidence of this phenomenon and its relationship with hemolysis was evaluated. Thirty-five consecutive patients with MMPV, each examined by transesophageal echocardiography (TEE), were divided into four groups: (1) no bright echoes (n = 11 patients); (2) minor echoes (+) (n = 11 patients); (3) moderate echoes (++) (n = 7 patients); and (4) numerous echoes (+++) (n = 6 patients). Hemolysis was evaluated from assays of serum haptoglobin, serum lactic dehydrogenase (LDH) and hydrobutyric dehydrogenase (HDH), plasma hemoglobin, indirect bilirubin, and LDH1 and LDH2 isoenzymes. Serum haptoglobin was significantly lower in the patients with bright echoes (0.17 vs 0.63; P < 0.05). In patients with (++) and (+++) bright echoes, the plasma hemoglobin levels and indirect bilirubin levels were significantly higher than the levels found in those patients with minor echoes or with no echoes. These results suggest that bright echoes in patients with MMPV are related to intravascular hemolysis, and the more intense the echo the more severe the hemolysis. Furthermore, there was a higher incidence of bright echoes in the patients with bileaflet prosthetic valves than in those fitted with the Björk valve (84.6% vs 22%). (ECHOCARDIOGRAPHY, Volume 13, July 1996)

Journal Article↗