Biomedical subjects

T Lefevre

Publications and source records attributed to T Lefevre.

5 recordsLinked to original sources

PubMed1989

[Intercoronary anastomoses of congenital origin. Apropos of a case].

Homo- or heterolateral intercoronary anastomoses are usually present in the normal heart. Owing to their small caliber they cannot be visualized at coronary arteriography, but they may become visible in case of obstructive coronary lesion. Congenital intercoronary anastomoses are entirely different. A case of intercoronary anastomosis between the right coronary artery and the circumflex artery, without any coronary lesion, is presented. This is an exceptional variant, only 12 cases of which were found in the literature. The anastomosis was located in the atrioventricular sulcus in 11 cases and in the interventricular sulcus in 1 case. This "abnormality" can be distinguished from collateral arteries by its angiographic features, and it does not reflect an underlying coronary disease. It may play a protective role if lesions develop on one of the two vessels it links together.

Adult↗

PubMed1989

[Myocardial infarction during or after exertion related to sports. Clinical and coronary angiographic analysis of 10 cases].

The purpose of this study was to analyse characteristic of myocardial infractions that occur during, or immediately after sport-related exertion in subjects who are neither athletes nor professional sportsmen and who undergo coronary angiography. Ten cases where myocardial infraction developed during (n = 3) or immediately after (n = 7) a game were studied retrospectively. All patients were men aged from 21 to 61 years (mean 48.8 years); 8 of them were smokers and 5 had hypercholesterolaemia. The sports practised were tennis (3), cycling (2), football (2), skiing (2) and weight-lifting (1). The infarction was inferior or basal in 5 cases, lateral in 1 case and anterior or anteroseptal in 4 cases. Coronary lesions involved one vessel in 6 and two vessels in 2 patients aged from 47 to 61 years. They were absent in 2 patients aged 24 and 26 respectively, with methylergonovine-induced spasm in one case. The outcome over a 2.9 years follow-up period was favorable, except for one death 6 months after the infarction (patient aged 24, normal coronary arteries, spasm). The outstanding features in this study are: (1) the occurrence of infraction during the recovery period and the noxious role played by smoking; (2) the contrast between the presence of atherosclerotic coronary lesions in middle age subjects and their absence in younger subjects (infarction due to spasm or thrombosis?), and (3) the possible usefulness of an exercise test in sport players of more than 40 years of age.

Adult↗

PubMed1989

[Value of the calibration of coronary angioplasty balloons].

A total of 197 polyethylene balloons of 2 to 4 mm diameter were inflated to 1 to 10 atmospheres to determine the variations of size with respect to pressure of inflation. A linear relationship was observed between diameter and pressure of inflation. The slope of this relationship represents the compliance. Balloons of the same diameter have almost identical compliances. The compliance of the balloon increases with size. The specified diameters are obtained with pressures of less than 6 atmospheres. However, the variations of size of a given balloon are important. This study shows that attention should be paid to the calibration of balloon catheters before angioplasty to avoid the risks of over-dilatation. New balloons made of therephtalane polyethylene are much less compliant and do not present this type of problem.

Angioplasty, Balloon, Coronary↗

PubMed1988

[Left coronaro-ventricular microfistula].

Microfistulae between coronary arteries and left ventricle have long been regarded as mere curiosities, but their frequency seems to have been underestimated. A review of 2,520 consecutive coronary arteriographies performed in adults has yielded 34 cases. In most of the 28 patients without infarction or valve disease, the symptoms were suggestive of coronary pathology. Signs of ischaemia were found at electrocardiography in 19 of these 28 patients, and exercise tests or myocardial scintigraphy were positive in 2 out of 3 cases. Patients' mean age was 53.4 years. The coronary arteriographic diagnosis was usually easy when technical conditions were perfect. The division of patients into two groups according to the presence or absence of significant coronary lesions revealed that the "isolated microfistulae" group was primarily composed of women (19/21). It is generally accepted that these fistulae are of embryonic origin, but their relation to atherosclerosis needs to be determined. The causes of ischaemic manifestations (coronary artery steal, global disturbances of myocardial microcirculation) are considered. Treatment is essentially medical, surgery being exceptional. Prognosis is habitually favourable (mean follow-up 28.3 months in our series). Thus, microfistulae between coronary arteries and left ventricle usually present as angina-like symptoms in women in their fifties who are free from atheromatous disease. They are found in more than 1 p. 100 of coronary arteriographies in adults, i.e. 8 p. 100 of "normal" coronary arteriographies. Their origin, the mechanisms of their symptoms and their relationship with the "so-called healthy coronary arteries angina" are obscure.

Coronary Angiography↗

PubMed1986

[Left coronaro-ventricular microfistulas. Apropos of 25 cases].

A retrospective study of 25 patients with left coronaroventricular microfistulae, investigated in the same vascular radiologic exploration unit, and data in the international literature were used to analyze these lesions in greater detail. Their frequency appears to have been underestimated since they represented 1.33% of coronarographies performed in adults in this series. Distribution into two groups as a function of presence or absence of significant coronary lesions, vascular disease or myocardial insufficiency showed that the group with isolated microfistulae was composed solely of women of about 50 years of age (16 cases). These patients presented typical angina with a simple course (absence of infarction), but a sometimes severe disability due to the symptomatology. The myocardial ischemia could result from a "coronary steal" phenomenon but other hypotheses have been evoked. Their congenital origin is widely accepted but their relation to atherosclerosis has not been established (cause, consequence or fortuitous association). They present specific images on routine coronarography. Treatment is symptomatic but surgical in exceptional cases with refractory, very disabling angina. Finally, detection of left coronaroventricular microfistulae should, when combined with metabolic studies, allow classification of the difficult problem of "angina with angiographically normal coronary arteries".

Aged↗