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Biomedical subjects

T Royer

Publications and source records attributed to T Royer.

At least 19 recordsLinked to original sources
PubMed2001

[Rupture of a sinus of Valsalva aneurysm in the left atrium].

Ruptures of sinus of Valsalva aneurysms are a rare complication, and very few cases of rupture in the left atrium have been described. In this clinical case we report the case of a patient hospitalised with a scenario of cardiac insufficiency revealing a very large posterior sinus of Valsalva aneurysm, associated with a bicuspid aortic valve, and rupture in the left atrium. The diagnosis was by transthoracic and transoesophageal multiplan echocardiography, and the treatment surgical, with a good result.

Aged↗
PubMed1999

A kinematic study of progressive apraxia with and without dementia.

BACKGROUND: Prehension is an ideationally simple, cued movement requiring proximal (transport) and distal (manipulation) limb control. Patients with this syndrome of progressive apraxia are unable to perform many activities of daily living that require prehension. There is little known about how this syndrome kinematically disrupts such movements or whether concurrent dementia might play a critical role. OBJECTIVES: Using prehension as a paradigm for an ideationally simple, cued functional movement, we sought to (1) characterize the kinematic features of progressive apraxia in general, and (2) contrast the kinematic differences between apraxic patients with and without dementia. METHODS: Eight patients with the syndrome of progressive apraxia (including five without dementia, one of whom had autopsy-confirmed corticobasal ganglionic degeneration, and three with dementia, one of whom had autopsy-confirmed Alzheimer's disease) were compared with eight age-matched normal control subjects on a prehension task using an Optotrak camera system. RESULTS: Compared with control subjects, apraxic subjects had slowed reaction time, slowed transport and manipulation kinematics, greater lateral deviation from the linear prehension trajectory, greater intermanual asymmetry, motor programming disturbances, and mild transport-manipulation uncoupling. There were minor differences between the apraxia subgroups such as greater intermanual differences and impaired grip aperture velocity in the nondemented group, and overall slower movement in the demented group. CONCLUSIONS: There are major kinematic differences between apraxic and control subjects on a prehension task. The differences between clinical-pathologic subgroups are more subtle, and the movement disorder itself rather than concurrent dementia is the greatest determinant of motor disability.

Aged↗
PubMed1999

[Pre-hospitalization treatment with Abciximab in the preparation of patients for primary angioplasty in the acute phase of myocardial infarct. Immediate and long-term (one month) results].

Percutaneous transluminal coronary angioplasty (PTCA) is an alternative to fibrinolysis in the treatment of acute myocardial infarction (AMI). However, after balloon PTCA, the rate of early re-occlusion, of re-infarctus and of restenosis remains high. Stent implantation with antiplatelet drug regimen (aspirin, ticlid) limits these risks. Abciximab (new GPIIb/IIIa receptors inhibitor) reduces PTCA complications rate in the acute coronary syndromes. Intravenous administration of abciximab can restore a normal flow in the infarcted related coronary artery (IRA) after few minutes. A monocentric, non randomized, prospective pilot study was iniated to assess the feasibility of pre-hospital treatment with abciximab in preparation to primary PTCA stenting in AMI (primary endpoint) and to appreciate potential benefits in initial IRA patency as well as prevention of PTCA thrombotic complications (secondary endpoint). Between April 1997 and January 1998, 38 AMI were treated with abciximab in pre-hospital phase (group A). Mobil Intensive Care Unit (MICU) team implemented the treatment and guaranteed immediate transport to the cathlab (abciximab bolus-coronary angiography time = 37 +/- 17 min). Immediate results were compared to those of 198 paired patients who were treated for AMI during the same period (Group T). Initial IRA flow TIMI grade 3 was significantly higher in group A, 24%, than in group T, 9% (p < 0.017). The rates of per-procedural complications (no flow, distal embolism), of local complications, of transfusions were not significantly different. During 1 month follow-up, there was no significant difference between group A and group T concerning death, re-MI, stent thrombosis and new revascularization. To conclude, the pre-hospital treatment with abciximab in AMI is feasible by MICU medical team without any delay of the cathlab admission. It is associated with no increased hemorrhagic complications rate. The abciximab pre-hospital treatment improves the initial IRA patency. These encouraging preliminary results expect to be confirmed by larger, multicentric, randomized and prospective studies.

Abciximab↗
PubMed1998

Placement of coronary stents in bifurcation lesions by the "culotte" technique.

Coronary angioplasty of bifurcation lesions remains a technical challenge. Balloon angioplasty induces recoil and the "snow-plow" effect with a risk of side branch occlusion. The late result is associated with a high rate of reintervention. Randomized studies in nonbifurcated lesions have demonstrated better short- and midterm results after stent placement. We propose the "culotte" technique as a new technique to place intracoronary stents in bifurcation lesions: implantation of 2 similar stents in 2 steps in the main branch and in the side branch with overlapping of the 2 stents in the main branch before bifurcation. We performed this technique in 50 patients (in the left anterior diagonal branch in 33, in the left circumflex obtuse marginal branch in 12, in the right coronary artery in 4, and in the left main coronary artery in 1). The clinical success rate was 94% with 3 non-Q-wave myocardial infarctions. Late results indicated a 24% target lesion revascularization rate, which improved when a true kissing balloon inflation was used to achieve final deployment of both stents. This culotte technique is highly feasible and provides excellent short-term results. Assessment of its midterm benefit requires further study.

Angioplasty, Balloon, Coronary↗
PubMed1998

Influence of Contrast Media on the Results of Percutaneous Transluminal Coronary Angioplasty with Provisional Stenting: A Comparative Study.

Contradictory data concerning the use of non-ionic contrast media during percutaneous coronary angioplasty (PTCA) have been published. Many clinical studies have suggested that a higher rate of PTCA complications (using balloon angioplasty) was observed using non-ionic versus ionic contrast media. In order to verify these results in the era of coronary stenting, we compared the in-hospital outcome of 384 patients (pts) dilated using ionic contrast media (ioxaglate) and 387 pts dilated with non ionic contrast media (iopamidol). From October 15th 1993 to July 15th 1994, 773 consecutive pts were included in this study. At the beginning of the procedure, the pts received a first bolus of heparin (7500 IU for pts who had not been pretreated with heparin and 5000 IU for pts already treated with heparin). After the first bolus the activated clotting time (ACT) was measured and the pts received an additional bolus of 2500 IU when the ACT was below 300 sec. When the procedure exceeded one hour an additional bolus of 5000 IU was injected. The main characteristics of the 2 groups (Ioxaglate vs Iopamidol) were comparable (demographic data, indication of PTCA, procedural data, first dose of heparin, total dose of heparin). The final ACT was higher in the ioxaglate group (634 +/- 111 vs. 474 +/- 310, p < 0.001). During the hospital course, blood transfusion or vascular surgery was necessary in 1.6 vs. 1.0% (NS), acute closure occurred in 2.1 vs. 4.9% (p = 0.03), acute Q-wave myocardial infarction in 0.5 vs. 0.75% (p = NS), emergency bypass surgery in 0 vs. 0.5% (NS), death in 0.8 vs. 0.3% (NS) and major cardiac event (death, myocardial infarction, coronary artery bypass surgery) in 0.8 vs. 1.6% (NS). Stents were less frequently used in the Ioxaglate group (21.5 vs. 28.5%, p = 0.03) especially in the subset of bailout stenting (2.0 vs. 4.9%, p = 0.04). CONCLUSION: This study suggests that PTCA with provisional stenting can be performed safely using ionic or non-ionic contrast media. However, the ACT obtained with the same dosage of heparin is significantly higher with the ionic contrast media whereas the risk of acute closure and the rate of bail-out coronary stenting is lower.

Journal Article↗
PubMed1997

Early versus late coronary stenting following acute myocardial infarction: results of the STENTIM I Study (French Registry of Stenting in Acute Myocardial Infarction).

This study was undertaken to determine the feasibility and safety of coronary stenting in acute myocardial infarction (AMI). In AMI, primary percutaneous transluminal coronary angioplasty (PTCA) is accepted as the preferred method of reperfusion for patients presenting at highly experienced centres. Until recently, however, stenting has been avoided during AMI because of a potential high risk of thrombosis. This prospective observational study carried out in 20 centres and included 648 consecutive patients who underwent PTCA with stent implantation for AMI. Of these 648 patients, 269 (41.5%, Group 1) were dilated early (< 24 hr) after the onset of the symptoms (75% treated by direct PTCA) and 379 (58.5%, Group 2) were dilated between 24 hr and 14 days after AMI. Combined therapy with ticlopidin and aspirin was used after the procedure. Bailout stenting occurred more often in Group 1 than in Group 2 (17% vs. 9.5%)(P < 0.05). Angiographic successful stenting was similar in both groups of patients (96% vs. 97%). During the hospital follow-up period, stent thrombosis occurred in eight patients (3%) in Group 1 and in six patients (1.6%) in Group 2 (NS). There was 14 deaths (5.2%) in Group 1 and 11 deaths (3.9%) in Group 2 (NS). After multivariate analysis bailout stenting was identified as the sole predictor of stent thrombosis (P < 0.0001). Vascular access-site complications occurred in six patients (1%) with no difference between the two groups. This study indicates that patients who receive a coronary stent in AMI can be managed safely with antiplatelet therapy. Randomized studies are needed to determine the precise indication for coronary stenting as an adjunct to primary PTCA.

Adult↗
PubMed1993

[Contribution of new technologies to the management of acute complications of coronary angioplasty].

This retrospective study of 4,000 coronary angioplasty procedures performed between 1/1/87 and 31/1/92 was undertaken to assess the benefits of new therapeutic options (perfusion balloon catheter, temporary and permanent stenting, laser balloon angioplasty, cardiopulmonary bypass) in the management of major complications of angioplasty and to evaluate the results of emergency coronary bypass surgery. Angioplasty was performed before (1,000 angioplasties: Group 1) and after (3,000 angioplasties: Group 2) the introduction of these new techniques at the Centre cardiologique du Nord. Despite the increasing complexity of the clinical and angiographic features of the patients, the global results show a significant decrease in the rates of emergency bypass surgery (2.1% in Group 1 versus 0.7% in Group 2; p < 0.0015) and of periprocedural acute myocardial infarctions (1.8% in Group 1 versus 0.7% in Group 2; p < 0.015). The use of these new techniques in cases of acute complications of coronary angioplasty decreases the signs of ischaemia before surgery (61.9% in Group 1 versus 68.1% in Group 2; p < 0.05). Coronary bypass surgery was performed under haemodynamically stable conditions in all patients requiring the procedure in Group 2, enabling the surgeon to perform more complete revascularisation with implantation of the mammary artery in 50% of cases (9.5% of cases in Group 1; p < 0.001). The interval to emergency bypass surgery depends mainly on the rapidity of the operative decision in cases of failure of these new techniques.

Angioplasty, Balloon↗
PubMed1992

[Value and limits of balloon laser-assisted angioplasty in the treatment of acute obstruction during percutaneous transluminal coronary angioplasty].

One of the problems of percutaneous transluminal coronary angioplasty is acute occlusion during the procedure, the main cause of serious complications and emergency coronary bypass surgery. Acute occlusion is generally related to severe intimal dissection and/or thrombosis. In animal experiments, it is possible to treat intimal dissection and dessicate thrombi by balloon laser angioplasty. Using this method, a programmed laser energy may be delivered to the arterial wall via a fiber optic system linked to a Nd:Yag laser during classical balloon inflation. This has been proposed for the treatment of acute coronary occlusion. Between September 1989 and August 1990, 923 patients underwent coronary angioplasty at the Centre Cardiologique du Nord. Peroperative acute occlusions occurred 52 times (3.9%) in 52 patients. Sixteen patients who were "candidates" for emergency coronary bypass surgery (residual stenosis > or = 75%; delayed flow; myocardial ischaemia) were treated by laser balloon angioplasty, 14 with success (87%). Two patients had to be operated as an emergency. There were no hospital deaths. The average follow-up was 4.7 months for the 14 non-operated patients. Systematic control coronary angiography was refused by 2 asymptomatic patients. In the other 12 patients investigated 1 to 17 months after the procedure, there were 10 restenoses (76%), 6 of which were treated by repeat angioplasty and 3 by coronary bypass surgery. These results show that balloon laser angioplasty is very effective in the treatment of peroperative acute occlusions, enabling emergency coronary bypass surgery to be avoided in 87% of cases, but it is associated with a very high restenosis rate which is difficult to accept.

Acute Disease↗
PubMed1991

[Retrograde dissection of the common trunk of the left coronary vessel during angioplasty of left anterior descending coronary artery. Apropos of 2 cases].

Acute dissection of the left main coronary artery during coronary angiography or angioplasty is a rare but well known complication; it is attributed to a mechanical trauma caused by the tip of the catheter guide wire. The authors present two cases of dissection at the site of coronary angioplasty with a retrograde extension to the left main stem requiring emergency coronary surgery.

Aged↗
PubMed1991

[Coronary angioplasty under extracorporeal circulation. Technique and experience of the Centre cardiologique du Nord].

Between May 1989 and April 1990, 21 patients, candidates for coronary angioplasty but with major left ventricular dysfunction, underwent the procedure using percutaneous cardiopulmonary support (CPS). All patients had one or more previous infarcts, severe angina, and 19 out of 21 had one or more episodes of cardiac failure. Angioplasty was carried out by the usual method, after establishing a percutaneous femoro-femoral CPS. Twenty-three procedures were performed and 22 successes were recorded without any complications (success = 95% per patient). There were no deaths, infarcts or emergency surgical referrals. Two patients required transfusion. The canulae were removed by compression. The only local complication was one case of deep vein thrombosis. The results of this short series suggest that myocardial revascularisation is possible with an acceptable risk in selected coronary patients with severe left ventricular dysfunction by coronary angioplasty with percutaneous cardiopulmonary support.

Adult↗
PubMed1990

"High-risk" percutaneous transluminal coronary angioplasty with preventive intra-aortic balloon counterpulsation.

Between January 1987 and February 1988, 1,385 patients underwent percutaneous transluminal coronary angioplasty; 27 procedures were performed using prophylactic intraaortic balloon counterpulsation. Twenty-four patients had poor left ventricular function (EF less than 40%), and coronary dilatation was performed in arteries opposite to an occluded myocardial necrosis related vessel. In three patients of advanced age with distal stenoses and normal left ventricular function a multivessel dilatation was performed. Primary success rate was achieved in all patients. There were no deaths, myocardial infarctions or emergency bypass operations in the hospitalization period. During the follow-up (9 to 21 months) there were 2 deaths, 1 cardiac transplantation, and 6 restenosis with repeated dilatation. If revascularization is warranted, in high-risk patients, coronary angioplasty can be performed safely and successfully with protection by intraaortic balloon counterpulsation. However the long-term prognosis of these patients is complicated by the presence of other high-risk variables, such as advanced age or poor left ventricular function.

Age Factors↗
PubMed1989

[Coronary angioplasty in the treatment of threatening extension of myocardial infarction].

Recurrent angina with reversible ECG changes within days of a myocardial infarction is a serious clinical entity associated with a high incidence of reinfarction and death. In this study, we report a one-year experience of the treatment and outcome of patients presenting early post-myocardial infarction angina. Out of 32 patients who underwent coronary angiography, 3 were treated medically, 4 were operated upon and 25 had coronary angioplasty at the same time as coronary angiography with a 100 p. 100 immediate success rate. Four early reocclusions were redilated successfully. While in hospital 3 of these 32 patients had myocardial infarct extension (very moderate in 2 cases with CPK less than 500 and a patent artery), and there was no death. During an 8-month follow-up period there were 3 late deaths and 2 reinfarctions; 4 patients were operated upon and 4 were redilated. Thus, angioplasty has a high success rate in early post-myocardial infarction angina, enabling most patients to get through an unstable phase. In some patients, however, the course of the disease is marred by secondary adverse events.

Adult↗
PubMed1989

[Extensive coronary dissection after percutaneous transluminal angioplasty. Apropos of a case].

The authors report a rare case of very extensive dissection of the right coronary artery immediately after angioplasty; the lesion was totally asymptomatic. Coronary bypass was performed 4 months later without complications and with a satisfactory result at a 15-month follow-up. Coronary dissection during angioplasty is usually located at the site of dilatation: its incidence varies from 6 to 13 p. 100 depending on the series reported. Facilitating factors are analysed, and the management of this complication is discussed: repeat angioplasty and/or emergency or elective coronary bypass, depending on the presence or absence of coronary thrombosis and symptoms, on the importance of the territory threatened and on the quality of collateral circulation.

Adult↗
PubMed1988

[A new procedure for the study and treatment of myocardial infarction in the acute phase: percutaneous coronary angioscopy].

The recent development of small diameter optical fibers, which are also very flexible allows us to realise percutaneous coronary angioscopy. First of all we visualized normal dog's arteries, bifurcations, origin of small branches; then we created and visualized intimal tears, dissections and experimental thrombi. The second part of this work consisted in applying this new technic in three patients who had an evolving myocardial infarction and an occluded right coronary artery. In all three cases a clot has been visualized, occluding the lumen of the artery. This small experiment shows that percutaneous angioscopy is a feasible, quick and save procedure. Its developments will be very important according to the development of percutaneous interventional therapies.

Animals↗
PubMed1985

[Median-term course of left ventricular effects in aortic insufficiency. Echocardiographic study of 90 patients].

It is important to know the natural evolution of the changes in left ventricular dimensions and contractility in AR if one wishes to determine the critical echocardiographic values at which LV function starts to deteriorate. This was the aim of our echocardiographic study of 90 patients with chronic pure AR in whom we analysed the changes in LV dimensions, mass and contractility for 11 to 84 months (average 34.6 months). The patients were divided into 2 groups according to the degree of ventricular dilatation (delta DD): Group A: delta DD less than 30% (58 patients), Group B: delta DD greater than 30% (32 patients). The annual mean increase in diastolic and systolic LV dimensions and myocardial mass in each group was: 1.5 mm vs 3.2 mm (p less than 0.02); 0.9 mm vs 4.1 mm (p less than 0.003), 14 g vs 24 g (p = 0.07 NS) respectively. The parameters of the systolic function were normal in Group A (EF = 68 +/- 8% and % FS = 38 +/- 6%) and decreased in Group B (EF = 58 +/- 13%, % FS = 32 +/- 9%). A significant annual decrease of the mean values of these parameters was only observed in patients of Group B (EF = 1.8% per year; % FS = -1.2% per year). These results are on average of unequal individual variations: variations of DD or EF greater than the variability due to the reproducibility of the method were only observed in 43 patients. The number of patients in whom echocardiographic changes were observed was comparable in Groups A and B.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

[Echocardiography in chronic aortic insufficiency. Prediction of the reversibility of left ventricular dysfunction following surgical correction].

UNLABELLED: The long term outcome of patients undergoing aortic valve replacement (AVR) for chronic aortic regurgitation (AR) is mainly determined by the reversibility or permanence of left ventricular dysfunction. We analysed the echocardiogram of 49 patients before and after surgery to identify the patients whose left ventricular dysfunction regressed completely after AVR. The patients were divided into 2 groups according to the results of the last postoperative echocardiogram: Group I: 25 patients whose left ventricular dimensions and wall motion reverted to normal; Group II: 24 patients with dilated and/or hypokinetic left ventricles. The two groups of patients were comparable for sex (Group I: 19 men, 6 women; Group II: 20 men, 4 women), age (Group I: 50,8 years, Group II: 53,9 years) and length of postoperative follow-up (Group I: 32 months, Group II: 34 months). The following parameters were measured and compared: diastolic and systolic left ventricular dimensions, myocardial mass and ventricular wall motion. RESULTS: Patients in Group I had less left ventricular dilatation than those in Group II (+35% vs +60%, p less than 0,001) and left ventricular contraction was better (FE: 62% vs 45%, p less than 0,001; %FS: 35% vs 23%, p less than 0,001). This study establishes that patients with chronic AR and % delta Dd less than 60%, an EF greater than 50% or %FS greater than 25%, have about a 90% probability of normalisation of LV function after AVR. If one of the indices exceeds these threshold values, the probability of permanent LV dilatation and/or hypokinesia after AVR is also about 90%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗