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T Anguenot

Publications and source records attributed to T Anguenot.

16 recordsLinked to original sources
PubMed1992

Long-term results of percutaneous aortic valvuloplasty compared with aortic valve replacement in patients more than 75 years old.

OBJECTIVES AND BACKGROUND: To assess the long-term results of percutaneous aortic valvuloplasty and aortic valve replacement in elderly persons, two similar nonrandomized series of patients greater than or equal to 75 years old treated by one or the other method between January 1986 and March 1989 in the same institution were compared. METHODS: Forty-six patients, 23 men and 23 women, with a mean age of 79.7 +/- 3.6 years (range 75 to 90) underwent percutaneous aortic valvuloplasty with use of the Cribier method (group 1). Twenty-three additional patients, 14 men and 9 women with a mean age of 78.4 +/- 2.4 years (range 75 to 86) underwent aortic valve replacement with a bioprosthesis (group 2). All of them suffered from severe calcified aortic stenosis. Clinical and hemodynamic status were similar in both groups. The mean follow-up period was 21.5 months (5 days to 60 months) in group 1 and 27.5 months (7 days to 61 months) in group 2. RESULTS: Three patients (6.5%) in group 1 died within 5 days after percutaneous aortic valvuloplasty; 24 patients (52%) died during the follow-up period, 16 of whom died of recurrent cardiac failure. Of 16 patients (35%) subsequently operated on at an average of 15.8 months after percutaneous aortic valvuloplasty, 2 died at operation. Only three group 1 patients (6.5%) are still alive without subsequent aortic valve replacement. In group 2, two patients (8.7%) died postoperatively and three (13%) died during the follow-up period. All other patients (78%) are still alive and in New York Heart Association functional class I or II. The overall survival rate in group 1 was 75% at 1 year, 47% at 2 years and 33% at 5 years. In group 2, the survival rate was 83% at 1 and 2 years and 75% at 3 and 4 years. CONCLUSIONS: The results of percutaneous aortic valvuloplasty do not compare favorably with those of surgery in elderly people, and this treatment should not be recommended.

Aged↗
PubMed1992

[Study of new thrombolytic agents in myocardial infarction: a multicenter randomized trial (APSAC versus rt-PA)].

A hundred and eighty three patients with a primary myocardial infarction less than 4 hours old were included in a double blind trial versus placebo comparing an isolated plasminogen streptokinase activator complex (APSAC: 30 mu in 5 mn) and tissue type plasminogen activator (rt PA: 10 mg bolus followed by 90 mg in 130 mn). Clinical evolution, side effects, patency of the artery responsible for infarction, left ventricular contractile function (contrast angiography on the 7th day and angioscintigraphy on the 21st day) and infarct size were studied. The two groups were comparable in age (54 +/- 11 years), delay in randomisation (170 +/- 50 mn), infarct site and severity of cardiac failure. There was no significant difference in hospital mortality (7 in the rt PA group and 5 in the APSAC group) or in adverse effects (haemorrhage: rt PA: 9 patients, APSAC: 11 patients). The patency was 72% in the APSAC and 76% in the rt PA group. Left ventricular function and infarct size were comparable in the two groups: angiographic EF (0.50 +/- 0.1 in the APSAC and 0.52 +/- 0.1 in the rt PA group: NS); asynergic score (11.3 +/- 1.7 in the APSAC and 10.5 +/- 1.8 in the rt PA group: NS); infarct size (10.9 +/- 8.0 in the APSAC and 9.4 +/- 7.2 in the rt PA group: NS). This trial shows that these two thrombolytic agents have the same efficacy. The authors recommend adaptation of the dosage of rt PA to body weight.

Adult↗
PubMed1992

[Arterial permeability, objective of thrombolytic therapy].

The effects of thrombolytic therapy in acute myocardial infarction are related exclusively to coronary arterial reperfusion. This is the main factor which influences myocardial salvage, the conservation of left ventricular function and, ultimately, the reduction in mortality. From the beginning of the 80s, the patency (or reperfusion) rate was arbitrarily assesses at 90 minutes. However, arterial reperfusion is a progressive phenomenon and the patency rate in a population of acute myocardial infarctions varies with time. Depending on the thrombolytic agent and the rate of administration, the patency increases at a variable rate attaining a plateau at the 4th-6th hour, the maximal patency being obtained between the 24th to the 48th hour. Therefore, assessing patency at the 90th minute of thrombolytic therapy is an approximate and relatively inaccurate method of assessing the efficacy of a given thrombolytic agent. When evaluating a thrombolytic drug administered at a certain dosage, the rate of reperfusion and the value and precocity of the plateau phase must be taken into account. The respective performances of different thrombolytics in terms of arterial patency are comparable. Nevertheless, the rate of reperfusion with Streptokinase given at the dose of 1.5 million i.v. in 60 minutes is lower than that obtained with more recent thrombolytic drugs. Streptokinase also appears to be less active on chronic thrombi. The late patency rate after the 24th hour is over 90% with nearly all thrombolytic drugs but it would seem to be less with rt-PA because of a higher reocclusion rate associated with this particular agent. The study of reocclusion requires control coronary angiography between the 24th and 72nd hour (7th day in some studies). The prevalence of this complication is influenced by several factors, especially the severity of residual stenosis after thrombolysis and the grade of perfusion obtained after the treatment: secondary reocclusion is significantly lower with long-acting and non-fibrin specific thrombolytic agents. It is approximately 2 to 5% with APSAC, Streptokinase and pro-urokinase, and two to three times greater with rt-PA. Finally, the use of more powerful antiplatelet drugs than those currently available and of specific anti-thrombin agents could reduce the rate of secondary reocclusion. Associations of thrombolytic agents, the development of thrombolytic chimera and new thrombolytic molecules could improve the efficacy of thrombolytic therapy in terms of capacity of reperfusion and tolerance, especially with respect to haemorrhagic complications.

Humans↗
PubMed1992

[Left ventricular remodeling after myocardial infarction].

Left ventricular remodeling describes a number of geometric and structural changes that the left ventricle undergoes after myocardial infarction. Briefly, it comprises expansion of the infarct and dilatation of the healthy left ventricular segments. Its severity is related to the infarct size. These changes in ventricular geometry, in particular the dilatation, influence the long-term incidence of cardiac failure, the main secondary complication of myocardial infarction. Up to now, therapeutic interventions have been oriented to reducing the infarct size with the aim of avoiding or delaying the occurrence of left ventricular dysfunction. Nowadays, it seems possible to influence the natural process of post-infarction. Left ventricular remodeling independently of efforts to reduce infarct size. There is evidence that this process may be limited pharmacologically with angiotensin converting enzyme inhibitors. In animal studies, these agents limit remodeling and improve survival after myocardial infarction, but for the moment, despite confirmed benefits on left ventricular modeling, it is not possible to extrapolate these results in terms of clinical mortality.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1991

Use of left ventricular function as an end point of thrombolytic therapy.

In recent acute myocardial infarction, early reperfusion of the infarct-related artery by intracoronary or intravenous thrombolytic therapy induces a significant limitation of infarct size, provided reperfusion occurs within a time frame that myocardial salvage can still be expected. Limitation of infarct size reduces scar tissue formation, aneurysm formation, infarct zone expansion, left ventricular volume enlargement, and eventually results in higher left ventricular ejection fraction. Infarct size limitation and left ventricular function preservation occur with all thrombolytic agents currently in clinical use: streptokinase, alteplase and, more recently, anistreplase. When anistreplase is compared with conventional heparin therapy, a 31% reduction in infarct size is found (estimated from single photon emission computed tomography, or SPECT). This translates into a significant preservation of left ventricular ejection fraction as observed in anistreplase-treated patients compared with heparin-treated patients (0.53 +/- 0.13 vs 0.47 +/- 0.12, p less than 0.002). In comparative trials of 2 thrombolytic agents, anistreplase was demonstrated to be as efficient as alteplase on left ventricular ejection fraction preservation and infarct size limitation.

Fibrinolytic Agents↗
PubMed1991

The double-balloon and Inoue techniques in percutaneous mitral valvuloplasty: comparative results in a series of 232 cases.

Immediate hemodynamic results of percutaneous mitral valvuloplasty were compared in two consecutive series of unselected patients from the same institution undergoing valvuloplasty with the double-balloon (161 patients) or the Inoue balloon (71 patients) technique. Before valvuloplasty, the patient series were comparable with regard to average age, gender repartition and most clinical, electrocardiographic, X-ray and hemodynamic variables. Poor anatomic forms of mitral stenosis were equally distributed in both series (41% vs. 45%, p = NS). The magnitude of mitral valve area increase and of mean mitral gradient decrease during percutaneous mitral valvuloplasty did not differ significantly in the Inoue balloon and double-balloon series (mean +/- SEM 1.1 +/- 0.2 to 1.95 +/- 0.5 and 1.0 +/- 0.2 to 1.97 +/- 0.5 cm2, respectively, for mitral valve area and 12 +/- 3 to 5 +/- 2 and 13 +/- 4 to 5 +/- 2 mm Hg, respectively, for mean mitral gradient). Four cases of 3+ mitral regurgitation occurred in the Inoue balloon series and 7 in the double-balloon series (p = NS). A good immediate result--defined as mitral valve area greater than or equal to 1.5 cm2 with greater than or equal to 25% in mitral valve area gain and mitral regurgitation less than 2+ at the end of the procedure--was observed in 78% of patients in both series. Three cases of tamponade due to chamber perforation and 14 cases of transient air embolism in the right coronary system due to balloon rupture were observed in the double-balloon series.(ABSTRACT TRUNCATED AT 250 WORDS)

Balloon Occlusion↗
PubMed1991

Percutaneous mitral valvulotomy in non-optimal candidates.

From 1987 to 1990, 215 patients aged 53 +/- 13 years underwent percutaneous mitral valvulotomy in our institution. Mean gradient dropped on average from 13 +/- 4 to 5 +/- 2 mmHg and mitral valve area increased from 1.0 +/- 0.26 to 1.97 +/- 0.5 cm2 at the end of the procedure. Good results, defined as mitral valve area greater than or equal to 1.5 cm2 and mitral regurgitation less than or equal to 2+ at the end of the procedure, were obtained in 78% of the cases. In 41 patients with a poor anatomical form of mitral stenosis, mean gradient decreased from 12 +/- 3 to 6 +/- 6 mmHg and mitral valve area increased from 1.0 +/- 0.3 to 1.7 +/- 0.5 cm2. Good results were obtained in only 50% of the patients. One third of the 3+ mitral regurgitation occurred in this subgroup of patients. In patients with prior surgical commissurotomy, in elderly people and in patients with associated valvulopathy or prosthetic aortic valve, the success rate was similarly low. A significant inverse relationship was found between X-ray and echo scores on the one hand and mitral valve area at the end of the procedure on the other, thus confirming that the results of percutaneous mitral valvulotomy are related to the anatomical form of mitral stenosis. However, patients with poor anatomical forms can undergo the procedure with an acceptable risk compared to benefit ratio.

Adolescent↗
PubMed1991

Comparative effects of APSAC and rt-PA on infarct size and left ventricular function in acute myocardial infarction. A multicenter randomized study.

BACKGROUND: Recombinant tissue-type plasminogen activator (rt-PA or alteplase) and anisoylated plasminogen streptokinase activator complex (APSAC or anistreplase) have been demonstrated to limit infarct size significantly and to preserve left ventricular function when injected soon after acute myocardial infarction. However, as yet, the efficacy and safety of these two thrombolytic agents have not been directly compared in one trial; this was the aim of this study. METHODS AND RESULTS: One hundred eighty-three patients suffering from a first acute myocardial infarction were randomly allocated to either APSAC (30 units over 5 minutes) or single-chain rt-PA (100 mg over a 3-hour period) within 4 hours of the onset of symptoms. Global and regional left ventricular function were assessed from contrast angiography an average of 5.3 +/- 2.3 days after initial therapy. Radionuclide angiography and thallium-201 single-photon emission computerized tomography were performed before hospital discharge. Infarct size was assessed by single-photon emission computerized tomography and expressed in percentage of the total myocardial volume. Ninety patients received APSAC and 93 received rt-PA within a mean period of 172 +/- 52 minutes after the onset of symptoms. The two groups were similar in age, location of the acute myocardial infarction, Killip class, and time of randomization. The patency rate of the infarct-related artery was 72% in the APSAC group and 76% in the rt-PA group (NS). Initial and predischarge left ventricular ejection fraction as well as infarct size were similar in both therapeutic groups (0.50 +/- 0.14 versus 0.52 +/- 0.12 for initial and 0.48 +/- 0.10 versus 0.47 +/- 0.10 for predischarge ejection fraction, 11 +/- 7% versus 9 +/- 7% for infarct size, respectively, for APSAC- and rt-PA-treated patients). Bleeding complications requiring blood transfusion occurred in one APSAC patient and in two rt-PA patients. One patient in the rt-PA group died of a massive intracranial hemorrhage. At the end of the 3-week follow-up period, five APSAC patients (5.5%) and seven rt-PA patients (7.5%) had died. CONCLUSIONS: The early infusion of APSAC or rt-PA in acute myocardial infarction produced a similar patency rate, limitation of infarct size, and preservation of left ventricular systolic function with an equivalent rate of bleeding complications.

Anistreplase↗
PubMed1991

[Percutaneous mitral valvuloplasty by Inoue's technique. Apropos of an experience of 71 cases].

Seventy-one consecutive, unselected patients underwent percutaneous mitral valvuloplasty by Inoue's technique between February and November 1990. The mean age was 53 years (range 32 to 75 years). Fifteen of the 71 patients had previously undergone surgical mitral commissurotomy. Three patients had Björk aortic valve prostheses. The mitral valve surface area increased from 1.1 +/- 0.2 cm2 to 1.95 +/- 0.5 cm2 (p less than 0.01) and the mean transmitral pressure gradient fell from 12 +/- 3 mmHg to 5 +/- 2 mmHg (p less than 0.05). Grade 3+ mitral regurgitation was observed in 4 patients. There were no cases of cardiac perforation or tamponade. The only complications were related to the catheterisation and not to the technique valvuloplasty (one case of prolonged fever which regressed with antibiotic therapy, one case of arteriovenous fistula at the site of femoral artery puncture). The QP/QS ratio was 1.1 +/- 0.2 at the end of the procedure. A QP/QS ratio greater than 1.5 was observed in one patient. A left-to-right shunt was observed in 53% of cases in the immediate post-valvuloplasty period with Doppler color flow imaging. In all, 78% of patients had a satisfactory result (mitral surface area greater than 1.5 cm2 and mitral regurgitation less than or equal to 2/4). These results are identical to those observed with the double balloon technique with a lower rate of complications. The duration of the procedure (104 +/- 13 min p less than 0.02) and of radioscopy (16 +/- 8 min, p less than 0.02) were shorter than with the double balloon technique.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Physiopathology of left ventricular remodeling after myocardial infarction].

The geometry of both the infarcted and non-infarcted zone of the left ventricle changes after myocardial infarction. Two mechanisms are involved: expansion of the infarcted zone and secondary dilatation of the non-infarcted zone. The necrosed area undergoes an inflammatory reaction followed by fibrosis which end up as a sca within a period of a few days to a few weeks. During this period if fibrous scarring the infarcted, thinned myocardium undergoes progressive expansion which starts in the first hours of the myocardial infarction. The loss of left ventricular systolic function related to the infarct and volumic overload created by expansion of the infarct influence the secondary development of dilatation of the non-infarcted zones. This dilatation results in restoration of left ventricular stroke volume but at the price of increased wall stress, which itself induces compensatory wall hypertrophy. These phenomena are more pronounced when the initial infarction is extensive and if they are sustained, they result in definitive myocardial failure. Several factors influence remodeling: the size of the infarct, arterial patency, wall stress and the quality of the scarring process itself. Therapeutic interventions of each of these factors can influence the remodeling. Limitation of infarct size by thrombolytic therapy, arterial revascularisation, even when performed late, seem capable of limiting expansion of the necrosed zone. Pharmacodynamic intervention of left ventricular afterload also affects ventricular remodeling. Nitrate derivatives, vasodilator therapy in general and converting enzyme inhibitors have been shown to be effective.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1991

[Arrhythmia in anesthesia and intensive care].

There is a high incidence of dysrhytmias in the operating room and I.C.U. Calling again diagnosis criteria using common leads of the E.E.G. leads to suggest a treatment approach taking the main effect of non cardiac factors in account, before the use of antiarrhythmic drugs. The Puech classification takes many data into consideration: electrophysiological properties, cardiac disease and trigger mechanism of dysrythmias. So, it is a better practice in a dysrythmia therapy to examine all these characteristics in order to choose an adjusted treatment.

Anesthesia, General↗
PubMed1990

Aortic valve area evolution after percutaneous aortic valvuloplasty. A prospective trial using a combined Doppler echocardiographic and haemodynamic method.

The aortic valve area was serially evaluated in 45 patients, mean age 78 years, suffering from severe aortic stenosis who underwent percutaneous aortic valvuloplasty. The aortic valve area was calculated from haemodynamic data prior to and immediately after the procedure using the mean gradient. Serial determinations of the aortic valve area were also obtained 1 day before, 1 day after and 2 months after valvuloplasty from the thermodilution cardiac output and Doppler echocardiography mean left ventricle-to-aorta gradient. The mean gradient significantly decreased from 75 +/- 24 to 42 +/- 16 mmHg (P less than 0.01) when measured from haemodynamic data and from 63 +/- 20 to 41 +/- 13 mmHg (P less than 0.01) when estimated from Doppler-derived data. It rose to 48 +/- 15 mmHg at 2 months (NS). The aortic valve area increased significantly from 0.48 +/- 0.13 to 0.67 +/- 0.29 cm2 (P less than 0.01) when calculated from haemodynamic data, and from 0.53 +/- 0.18 to 0.74 +/- 0.23 cm2 (P less than 0.01) when estimated from Doppler-derived data. It declined to 0.69 +/- 0.27 cm2 at 2 months (NS). Aortic valve area values determined from haemodynamic data and from Doppler-derived data correlated well before valvuloplasty (r = 0.80, P less than 0.01) but poorly afterwards (r = 0.57, P less than 0.01). The aortic valve area was not influenced by valvuloplasty in eight patients. At 2 months, restenosis was apparent in eight patients out of 32 that were re-evaluated. Three patients died within 5 days of the procedure. After an average 12 months' follow-up, eight more patients died. Symptoms were not influenced or recurred in 17 patients, while 17 others remained improved by at least one NYHA functional class. Seven patients were operated on, and there was one operative death. The calculated aortic valve area was significantly greater at the end of the procedure in the patients with persistent improvement compared with those with a poor result (0.83 +/- 0.29 cm2 vs 0.65 +/- 0.14 cm2, P less than 0.05). In conclusion, in this study one third of the patients submitted to percutaneous aortic valvuloplasty had no objective improvement in calculated valve area or early restenosis after 2 months. Functional improvement was observed in one third of the patients. Immediate re-estimation of the aortic valve area from haemodynamic data at the end of the procedure may not reflect the actual effect of valvuloplasty on the aortic orifice.

Aged↗
PubMed1990

[Effect of thrombolytic agents on infarct size and left ventricle systolic function in myocardial infarction].

The early intravenous administration of thrombolytic agents in the acute phase of myocardial infarction induces reperfusion of the artery responsible for the necrosis, thereby limiting the size of the infarct and preserving the left ventricular systolic function with consequent reduction of short- or long-term mortality. With the exception of urokinase, these effects have been demonstrated with all thrombolytic agents used so far, including streptokinase, plasminogen tissue activator and anistreplase. Owing to its special pharmacokinetic properties, the latest thrombolytic agent, formerly known as APSAC (anisoylated plasminogen streptokinase activator complex), provides a high arterial reperfusion rate with a low percentage of reocclusion. As a result, the mean size of the infarct is reduced by 31 per cent (36% in the case of anterior infarct), and the left ventricular systolic function is highly significantly preserved.

Anistreplase↗
PubMed1990

[Anisoylated plasminogen streptokinase complex during the acute phase of myocardial infarction. Results of a multicenter double-blind study versus heparin].

Two hundred and thirty-one patients admitted to hospital within 5 hours of the onset of symptoms of a primary myocardial infarction were randomised into 2 groups: one received thrombolytic therapy [anisoylated plasminogen streptokinase activator complex (APSAC): 30 IU in 5 minutes] and the other was given conventional heparin therapy (5,000 IU). Heparin was given to both groups 4 hours later (500 IU/kg/day); the APSAC (N = 119) was identical with respect to age, location of infarct, Killip classification, delay before randomisation (188 +/- 62 minutes). Coronary angiography and ventriculography were performed after 3.4 +/- 1.2 days, and angioscintigraphy and myocardial scintigraphy after 19 +/- 2.5 days to determine the size of the infarct and the quality of left ventricular function. Coronary patency was much higher in the APSAC group (77%) than the heparin group (37%) (p less than 0.001). The angiographic ejection fraction was significantly greater in the thrombolytic group than in the heparin group (53 +/- 13% vs 47 +/- 12%, p less than 0.002), the difference being statistically significant in the anterior and inferior infarct subgroups. At the third week, the difference remained significant in the anterior infarct subgroup: a 31 per cent reduction in necrosed myocardial mass was observed in the APSAC group (33% in anterior infarcts: p less than 0.05 and 16% in inferior infarcts: NS). The limitation of infarct size explained the smaller reduction in left ventricular systolic function (r = 0.73; p less than 0.01). The hospital and one year mortality was comparable in the two groups which was not surprising given the small number of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Anistreplase↗
PubMed1989

Multicenter trial of intravenous anisoylated plasminogen streptokinase activator complex (APSAC) in acute myocardial infarction: effects on infarct size and left ventricular function.

Two hundred thirty-one patients with a first acute myocardial infarction were randomly allocated within 5 h after the onset of symptoms either to treatment with anisoylated plasminogen streptokinase activator complex (APSAC), 30 U over 5 min, or to conventional heparin therapy, 5,000 IU in a bolus injection. Heparin was reintroduced in both groups 4 h after initial therapy at a dosage of 500 IU/kg per day. One hundred twelve patients received APSAC and 119 received heparin within a mean period of 188 +/- 62 min after the onset of symptoms. Both groups were similar in age, location of the acute myocardial infarction, Killip functional class and time of randomization. Elective coronary arteriography was performed on an average of 4 +/- 1.2 days after initial therapy. Follow-up radionuclide angiography and thallium-201 single photon emission computed tomography were performed before hospital discharge. Infarct size was estimated from single photon emission computed tomography and expressed as a percent of total myocardial volume. The patency rate of the infarct-related artery was 77% in the APSAC group and 36% in the heparin group (p less than 0.001). Left ventricular ejection fraction determined from contrast angiography was significantly higher in the APSAC group than in the heparin group. This was true for the entire study group (0.53 +/- 0.13 versus 0.47 +/- 0.12; p = 0.002) as well as for the subgroups of patients with anterior and inferior wall infarction (0.47 +/- 0.13 versus 0.40 +/- 0.11; p = 0.04 and 0.56 +/- 0.10 versus 0.51 +/- 0.11; p = 0.02, respectively). At 3 weeks, the difference remained significant for the anterior myocardial infarction subgroup. A significant 31% reduction in infarct size was found in the APSAC group (33% for the anterior infarction subgroup [p less than 0.05] and 16% for the inferior infarction subgroup [p = NS]). A close inverse relation was found between the values of left ventricular ejection fraction and infarct size (r = -0.73, p less than 0.01). By the end of a 3 week follow-up period, seven APSAC-treated patients and six heparin-treated patients had died. In conclusion, the early infusion of APSAC in acute myocardial infarction produced a high early patency rate, significant limitation of infarct size and significant preservation of left ventricular systolic function, mainly in anterior wall infarction.

Acute Disease↗