Biomedical subjects
Publications and source records attributed to X Favereau.
The association of tetralogy of Fallot and mitral stenosis is extremely rare. This is probably the first description of this association. The clinical and haemodynamic presentation is similar to that of cyanotic heart disease with pulmonary stenosis and post-capillary pulmonary hypertension. The mitral stenosis was probably congenital as it was diagnosed at 14 months of age.
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The Orion coronary angioplasty improved balloon on a wire system was used in 42 patients (53 stenoses) including 5 patients with acute myocardial infarction, 18 patients with unstable angina, and 4 patients with kissing balloon angioplasty via a single guiding catheter. All stenoses were crossed successfully and the immediate and in-hospital success rates were 98 and 93%, respectively. The simple construction, low profile, and improved steerability allowed successful and quick angioplasty of high grade stenotic lesions. This balloon catheter represents a significant advance in angioplasty technology.
Ambulatory coronary arteriography was carried out in 160 patients in the first 18 months' activity of our department (9.5% of all cardiac catheterisations and 16% of all coronary arteriographies during the same period). An absolutely stable clinical condition was the main criterion of selection for this investigation and the protocol consisted in day hospital admission, absence of routine anticoagulation, small calibre (5 French = 1.7 mm) catheters, mobilisation 4 hours and discharge 6 hours after the procedure. The patients were 38 women and 122 men whose average age was 55 years. The percutaneous femoral approach was used in most cases (95%). Single or multiple coronary artery disease was documented in 55 per cent of these patients: there were 2 cases of left main stem stenosis. Eight patients required full hospital admission, mainly because of the severity of the coronary lesions. Minor complications occurred in 2 per cent of cases. These results indicate that ambulatory coronary arteriography is safe, effective and economic. It could be used more extensively always providing that the contra-indications are respected.
Since the first percutaneous transluminal coronary angioplasty performed in 1977 by Andreas Grüntzig, this non surgical technique has become an established method of myocardial revascularization. This overall report reviews the experience of the last ten years, acquired on several hundred thousand patients. We have especially detailed the chapters concerning the immediate and late results, restenosis, the "Achilles" heel of angioplasty, and concerning the indications, especially stressing multivessel disease and acute myocardial infarction, topics which are currently relatively controverted.
Owing to the ever growing practice of coronary angioplasty, each patient is subjected to multiple examinations and it has become imperative, both for ethical and functional reasons, to reduce the morbidity of coronary arteriography. For this purpose, reduction in the caliber of catheters is a step forward which must be made without altering the procedure and even while making it simpler (shorter stay in bed and in hospital). Between april, 1986 and january, 1987, 300 consecutive coronary arteriographies were performed in a uniform manner and using 5 French catheters in 239 men (mean age 55.4 years) and 61 women (mean age 60.3 years). There were 13 "failures" (4 p. 100) in the sense that the examination was pursued with conventional 7 F or 8 F catheters, or that the brachial route was used. Bilateral femoral puncture was necessary in 6 cases (2 p. 100), and 2 complications (0.7 p. 100) were observed: subacute femoral thrombosis in one case, and regressive cerebral vascular accident in another patient. Thus, it seems permissible and more convenient nowadays to perform all coronary arteriographies with a 5 French catheter. The femoral route can be used in ambulatory patients who get up 4 hours after the procedure.
Fifty-two patients with primary transmural infero-posterior infarcts underwent right heart catheterisation on admission to hospital and coronary angiography between the 7th day and 4th month after onset of symptoms. The patients were divided into two groups A (N = 34) with signs of right ventricular dysfunction on admission indicating biventricular infarction, and B (N = 18) without right ventricular dysfunction classified as isolated LV infarction. No significant differences were observed between the two groups with respect to: global and regional LV function; the incidence of single, double and triple vessel disease; the incidence and location of right coronary artery thrombosis; the incidence and location of lesions of the left coronary tree (LCA, LAD, Cx); the extent of coronary disease (Gensini score); the dominant artery (right coronary/circumflex), the frequency and quality of revascularisation of distal vessels. The only significant differences were the higher incidence of severe lesions (90 p. 100) of the right coronary and circumflex arteries and of stenosis of the first large septal branch of the LAD artery in Group A (p less than 0.05). These results show that the indications for coronary angiography in biventricular inferior infarction are no greater than those in mono LV inferior infarction. This supports experimental data on the physiopathology of RV infarction which demonstrates that except in cases of proximal thrombosis of the right coronary artery, the possibilities of revascularisation from the left coronary tree are limited.
The authors report two cases of fissures of a left ventricular aneurysm diagnosed on the 8th and 21st days following an anterior myocardial infarction. In both cases, the clinical presentation consisted of a new episode of pain associated with a low cardiac output syndrome and adiastole. The diagnosis was confirmed by the simultaneous discovery of a pericardial effusion and a left ventricular aneurysm on echocardiography and cardiac catheterisation. An emergency operation, with circulatory assistance by means of intra-aortic counter-pressure, was performed and the infarcted area was excised. The post-operative course was uncomplicated in one case, but the other patient developed a false aneurysm of the left ventricle, requiring a second operation. The long term results were excellent with a follow-up of 30 months and 12 months respectively.
Tricuspid insufficiency (TI) has already been reported as a possible complication of biventricular infarction. However, in the absence of large study groups, this condition is not well known. This paper reports the results of 2 studies: a retrospective study of 91 biventricular infarcts, identified by haemodynamic criteria, and a prospective study of 23 consecutive patients (belonging to the previous group) in whom selective right ventricular cineangiography was performed in the acute phase. The following conclusions were drawn: moderate to severe TI is very common during the first days of infarction (30%/39%); the diagnosis is simple, based on non invasive, very sensitive (89%) and specific (100%) haemodynamic criteria; it is associated with a much more severe clinical and haemodynamic presentation and with a higher mortality in the acute phase (37% vs 6.2% in the global study); the poor prognosis does not persist in the long term; regression is common (2/3 to 3/4 of cases) and angiographic data suggests that it is often related to a transient ischaemic papillary muscle dysfunction. Acute paralysis of the right atrium may also play a major role; the TI remains unchanged only in rare cases and may then be responsible for a chronic right ventricular dysfunction and then raise the question of surgical intervention.
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In discussing a case of isolated A-V block, the authors note that this condition occurs frequently in association with other cardiac and non-cardiac foetal malformations. Diagnosis of this type of disorder has been greatly facilitated by the development of ultrasonography. Obstetric management depends on the degree of malformation. Neonatal monitoring is mandatory, as is the presence of a paediatric ressuscitation team at delivery.
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The simultaneous prescription of a calcium channel blocker and a cardiac glycoside is a frequently used therapeutic combination in cardiology, although its consequences on inotropism have not been really evaluated. This association is studied on isolated rat heart perfused at constant coronary pressure, paced at a constant frequency and working against a left intraventricular balloon. Since the inotropic effects are dependent on the basic level of myocardium contractility, controls were made hypocontractile by lowering external calcium level to 0.25 mM. For the same initial systolic pressure (45 mm Hg) and + dP/dTmax (150 mm Hg X s-1) the inotropic effect of 10(-5) M ouabain was significantly less pronounced in the presence of 10(-6) M verapamil or 10(-7) M nifedipine at 2.5 mM CaCl2 than at the low external calcium concentration of 0.25 mM (increasing the + dP/dtmax by 35% +/- 4, 29% +/- 6 and 110% +/- 18 respectively). Since we know that the inotropic properties of digitalis are probably due to an increase of the slow calcium inward current, we conclude that the observed effect would be due to a blockade of these channels by calcium blockers.