PubMed Health⌕ Search

Biomedical subjects

Y Pansard

Publications and source records attributed to Y Pansard.

At least 19 recordsLinked to original sources
PubMed1995

The O'Brien-Angell stentless porcine valve: early results with 150 implants.

From August 1991 to June 1994, 150 patients underwent aortic valve replacement with the O'Brien-Angell stentless porcine xenograft (Bravo Cardiovascular Model 300, Cryolife, Atlanta, GA). To establish trends we analyzed three consecutive groups of 50 patients. We found significant differences in low postoperative gradients (mean < or = 10 mm Hg): 24% in group 1, 42% in group 2, and 96% in group 3. Comparing groups 1 and 3, gradients were significantly lower in all valve sizes. The difference is credited to better supraannular positioning of the valve, which is the key to the learning curve. Trivial central regurgitation was present in the three groups at 6%, 12%, and 0%, respectively. Peripheral regurgitation was trivial in 6%, 8%, and 0%, and mild to moderate in 4%, 2% and 0%, respectively. Seventy-eight of 107 patients with an available follow-up exceeding 1 year had noninvasive controls. Two early cases with moderate perivalvular leaks evolved to moderately severe leaks. Two valves were explanted. The O'Brien-Angell stentless valve is easy to handle and correct supraannular positioning provides excellent hemodynamic results.

Adult↗
PubMed1995

Cardiac valve replacement in relapsing polychondritis. A review.

Cardiac valve replacement is a rare but not exceptional eventuality in patients with relapsing polychondritis. One case requiring aortic and mitral valve replacement and its follow up is described. From the review of the literature an additional twenty patients who required cardiac valve replacement are analyzed. The mean delay between the first onset of relapsing polychondritis and operation was 6.51 years and the mean age at operation was 38.8 years. There was a preponderance of male patients (73.7%). Aortic and mitral valves were replaced in 100% and 28.5% of patients, respectively. During the four first postoperative years 23.8% of them were reoperated for periprosthetic leak or aortic aneurysm, and during the same period 52.6% died of a cardiovascular cause. Immunosuppressive agents should be employed in patients with relapsing polychondritis and cardiovascular involvement because they seem to be more effective than steroids in severe forms of the disease. Therefore, we recommend close and prolonged follow up: firstly because there can be early paravalvular prosthetic leakage due to the friability of the tissue to which it has been anchored; secondly because aortic aneurysms occur frequently in relapsing polychondritis, may be multiple, may involve all parts of the aorta and result in fatal rupture even in asymptomatic patients; and thirdly because there can be a fatal outcome due to other organ involvement, like airway obstruction, acute glomerulonephritis, or systemic vasculitis. Prophylactic composite graft replacement of the ascending aorta associated with replacement of the aortic valve and re-implantation of the coronary arteries could avoid the need for reoperation in these high risk patients.

Adult↗
PubMed1994

Successful resection of giant intrapericardial lipoma.

We report a case of giant extracavitary cardiac lipoma weighing 4,800 g. The mode of presentation, the preoperative evaluation, and the radiographic features are presented. The surgical management of this very rare cardiac pathology is discussed. This is one of the largest cardiac tumors ever reported.

Adult↗
PubMed1994

The O'Brien-Angell stentless valve. Early results of 100 implants.

From August 1991 to May 1993, 100 unselected consecutive patients in whom an aortic bioprosthesis was indicated underwent aortic valve replacement with the O'Brien-Angell stentless porcine xenograft (Bravo Cardiovascular Model 300). The indication was calcified aortic stenosis (AS) in 62 cases (isolated in 44, with associated cardiac lesions in 18), aortic insufficiency in 24 cases (isolated in 13 with associated cardiac lesions in 11), and redo operations in 14 cases. Forty-four percent of the patients were over 70 years of age. With the recommended supra-annular single running suture technique, the aortic cross-clamp times in isolated procedures ranged from 32 to 70 min, mean 39 min. Valve function was studied by echocardiography in 92 patients. Early post-operative transvalvular gradients were usually in the low range, below 15 mmHg in 68% of the cases. Isolated central valvular regurgitation was absent in 60.8%, "microscopic to trivial in 31.5% and mild to moderate in 1.2%. Perivalvular regurgitation was absent in 65.2%, microscopic to trivial in 26.2% and mild to moderate in 3.2%. Thirty-five of 40 patients with follow-ups exceeding 6 months had non-invasive controls. Transvalvular gradients showed a 30 to 40% reduction when compared to the immediate postoperative values. There were no new isolated central regurgitations but in two cases previously mild-to-moderate perivalvular leaks evolved to moderately severe leaks. Two valves were explanted, one for rupture of a Prolene 4/0 and one due to a slack Prolene 4/0 suture. We consider that the O'Brien-Angell stentless valve was easy to handle in all situations encountered.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Functional capacity after cardiac transplantation].

Cardiac transplantation has transformed the prognosis of NYHA Class IV severe cardiac failure. However, despite a "new heart", the exercise tolerance of transplanted patients remains poor for a long time. Cardiac denervation which decreases the chronotropic reserve, diastolic left ventricular dysfunction and intrinsic muscular abnormalities related to lack of training and to treatment are the underlying causes.

Cardiovascular Deconditioning↗
PubMed1994

[Thromboses of heart valve prostheses: predisposing and prognostic factors based on a study of 41 patients].

Forty one patients were admitted with a diagnosis of prosthetic valve thrombosis. One patient was thrombolyzed successfully, and 40 underwent surgical procedures. In 13 cases, prosthetic valve thrombosis occurred in the first month after valve replacement. 18 patients were in functional class IV of the NYHA classification. Among the thrombosed prostheses, 91% were mechanical, and 61% in mitral position. Adequacy of anticoagulation was the most important risk factor, as this treatment was inappropriate in 20 patients. In 10 other patients, it had been changed for medical (bleeding events, pregnancy) or surgical (non cardiac surgery) reasons. The perioperative mortality rate was high (32.4%). It was 12% in patients in functional class II and 46% in those in class IV (p < 0.05). This underlines the value of early diagnosis, in which echocardiography, especially with a transesophageal probe, takes a major place, allowing prompt surgical treatment.

Adult↗
PubMed1992

Bicaval pulmonary connection in tricuspid atresia using an extracardiac tube of autologous pediculated pericardium to bridge inferior vena cava.

From August 1989 to April 1991, four children, 1.5 to 4 years old with type IIb tricuspid atresia underwent total right heart bypass by means of a bicaval pulmonary connection using an extracardiac conduit of pediculated pericardium between the inferior vena cava and the main pulmonary artery. The tube was made from a large rectangular flap of the patient's own pericardium, pediculated along the right border, ensuring a vascular supply. The diameter of the tube, calibrated on a Hegar probe, equals that of the inferior vena cava, and the length is adapted to bridge the gap between the inferior vena cava and the main pulmonary artery. All four patients had an uneventful postoperative course. Assisted ventilation was stopped on the next morning and the chest tubes removed on the 2nd or 3rd day. The liver was only moderately enlarged and no pleural effusions developed. Sinus rhythm was permanent. Echocardiographic monitoring 6-10 months after the hospital discharge showed patent tubes, no collapse during the cardiac cycle, and no wall thickening and a laminar flow. The advantages of the pediculated pericardial tube are that no prosthetic material is used. There is no thrombogenicity or antigenicity. These tubes retain a growth potential, and we believe that this material is suitable for use in young patients.

Child, Preschool↗
PubMed1992

[Extracardiac pulmonary bypass in the treatment of tricuspid atresia].

Six patients aged 1.5 to 4 years with type 13 tricuspid atresia underwent extracardiac bicavopulmonary repair. This corrective procedure comprises control of palliative aorto-pulmonary anastomosis, the construction of an anastomosis between the superior vena cava and right pulmonary artery and the interposition of an extracardiac tube of autologous pediculated pericardium between the inferior vena cava and the main pulmonary artery. This tube, fashioned from a rectangular flap, remains attached along its right border, conserving its vascular pedicle with the pericardium. Its diameter is calibrated to that of the inferior vena cava. The postoperative course was uncomplicated: all children survived. Assisted respiration was discontinued 24 to 36 hours after surgery, and the pleural drains withdrawn after 48 to 72 hours. The rhythm remained sinusal. Central venous pressure ranged from 8 to 12 mmHg. Peripheral arterial situation was over 95%. At follow-up at 3 to 15 months, the children were very active, reflecting good exercise capacity. Holter monitoring was normal. Saturation was 94 to 97%. Doppler echocardiography showed laminar blood flow. This technique insures good venous drainage without any prosthetic thrombogenic material. In addition, the pediculated pericardium conserves a potential for growth, justifying its use in small children. Long-term evaluation is essential but the initial results are encouraging and encourage perseverance with this method.

Anastomosis, Surgical↗
PubMed1991

[Interrupted aortic arch. A series of 15 patients].

Between 1983 and 1989, 15 children underwent surgical repair of interrupted aortic arch at 1 to 20 days of age. The anatomical form was a Celoria and Patton type B in all patients with an associated perimembranous ventricular septal defect in all but one who had multiple ventricular septal defects, and patent ductus arteriosus. Six children had a retro-esophageal right subclavian artery, two had subaortic stenosis and two had a right-sided descending thoracic aorta. In two children with severe hypoplasia of the ascending aorta the repair was performed in one stage with two deaths due to left ventricular failure. In the other B cases, a two-stage repair was carried out. The reconstruction of the aortic arch varied according to the individual case. All children had pulmonary artery banding. Seven children survived longer than 30 days. Six of them later underwent a complete repair. The only survivors were those patients in whom the neo-aortic arch grew harmoniously. The authors conclude that: a two-stage repair gave disappointing results in this series of consecutive patients, mainly because of the poor quality of the reconstruction of the aortic arch by thoracotomy.

Anastomosis, Surgical↗
PubMed1991

[Early results of coronary surgery in patients between 71 and 80 years of age].

One hundred consecutive patients aged 71 to 80 without other cardiac pathology underwent coronary bypass surgery by the same surgical team between January 1986 and May 1989. These patients were recruited from a group of 687 patients undergoing coronary bypass surgery in the same period. The indication was always based on the severity of clinical symptoms resistant to medical therapy. Recent unstable angina despite triple therapy was a particularly common indication in this group of patients (61%). Preoperative coronary angiography showed a high incidence of triple vessel (62 cases) and left main stem disease (23 cases). Double vessel (12 cases) and single vessel disease (3 cases) were less common. Preoperative myocardial infarction was observed in 35% of cases; the site was nearly always on the inferior wall. In all, 230 bypasses were performed including 23 internal mammary artery bypasses (average 2.3 bypasses per patient). Six patients developed perioperative myocardial infarction confirmed by ECG and a rise in cardiac enzymes in 4 cases and by a rise in the cardiac enzymes alone in 2 cases. The mortality was low in this group of patients (3%). This was due to strict selection of patients in this age group and also to the improvement in the techniques of myocardial protection, anaesthesia and intensive care. Our results justify the operative indications in this group of patients in whom medical therapy has failed.

Age Factors↗
PubMed1990

Beta-adrenergic receptor changes during coronary artery bypass grafting.

To evaluate whether the function of beta-adrenergic receptors, essential to the biologic activity of catecholamines, is altered during coronary artery bypass grafting, we measured, in 16 patients undergoing myocardial revascularization, the density and the affinity of lymphocyte beta-adrenergic receptors before anesthesia induction (control) and at the end of cardiopulmonary bypass. Variations in the density and affinity of beta-adrenergic receptors were determined in vitro. Repeated determinations of plasma epinephrine and norepinephrine concentrations were also performed. Overall, no significant modification was observed in mean density and affinity of beta-adrenergic receptors at the end of cardiopulmonary bypass when compared with control values. However, a significant decrease (p less than 0.05) in affinity for isoproterenol was found in the six patients who had high catecholamine levels during cardiopulmonary bypass. In contrast, no significant modification of beta-adrenoreceptor affinity for isoproterenol was observed in the 10 patients who did not have this degree of adrenergic activation. In addition, beta-adrenoreceptor affinity for isoproterenol was decreased in the three patients in whom intraaortic balloon pumping was mandatory after discontinuation of cardiopulmonary bypass. We suggest that this decreased affinity of lymphocyte beta-adrenergic receptors could be related, at least in part, to a sustained adrenergic activation occurring in some patients during cardiopulmonary bypass.

Anesthesia↗
PubMed1989

[Immediate postoperative results following conservative surgery of rheumatic mitral valve insufficiency in children].

The immediate post-operative results of conservative surgery were evaluated objectively in 31 children aged under 13 years referred to us for surgical correction of severe rheumatic mitral valve regurgitation. 16 patients had pure mitral regurgitation. In the others, lesions which required additional surgery were aortic regurgitation in 7 cases, tricuspid of the mitral valve and left ventricle was studied by two-dimensional TM-mode echocardiography. This examination was combined with a pulsed doppler study in search of a possible residual mitral regurgitation signal, with special attention to the depth at which it was recorded in the left atrium -- a semi-quantitative indication of the severity of residual leakage. Two mitral valve replacements were performed, and two early reoperations were needed for residual regurgitation developed between the 5th and 8th post-operative days. Three deaths occurred due to supra-systemic pulmonary arterial hypertension. The post-operative evaluation of mitral valvuloplasty results therefore involved 25 patients. In the absence of significant residual mitral regurgitation, two-dimensional echocardiography was inconclusive since the images obtained varied considerably according to the surgical procedures performed. There was a distinct reduction of end-diastolic diameters (43.5 +/- 5.9 versus 62.1 +/- 8.7 mm pre-operatively), reflecting the disappearance or marked decrease of the pre-operative ventricular volume overload consecutive to mitral regurgitation. The reduction of end-systolic diameters was also significant (31.2 +/- 6.7 mm versus 39.2 +/- 7.1 mm pre-operatively), though less pronounced than that of end-diastolic diameters, which explains the diminution observed in the percentage of fibre shortening, although the figures remained within normal limits (28.7 +/- 9.7 p. 100 versus 37.0 +/- 6.8 p. 100).(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Surgical Procedures↗
PubMed1989

[Subaortic fibromuscular tunnel following resection of accessory mitral tissue. Surgical treatment].

When accessory mitral valve tissue obstructs the left ventricular outflow tract resection is considered a sufficient and definitive procedure. We report the unusual case of a child who had undergone such resection at the age of 4 years and who developed, over a few years, a recurrent subvalvular aortic obstacle consisting, this time, in a fibromuscular tunnel. In a second operation performed at the age of 12, a septal patch was inserted to widen the subaortic channel which was approached through a trans-septal infundibular route. Control examination showed a satisfactory pressure gradient and a sinus rhythm.

Child, Preschool↗
PubMed1989

[Abnormalities of the aortic arch in adults. A rare cause of tracheo-oesophageal compression. Apropos of 2 cases].

Two cases of symptomatic aortic arch anomalies in adults are reported: a case of Neuhauser's ligamentum arteriosum with compressive retro-oesophageal diverticulum, and a case of double aortic arch revealed by postoperative tracheal compression. In both cases, surgical correction was made very difficult by the aneurysmal progression of the compressive vascular anomalies and resection of the thoracic aorta under cardiopulmonary by-pass was necessary. These therapeutic difficulties therefore highlight the differences between aortic arch anomalies in adults and those in infants which can be simply and effectively treated with no mortality in our experience. These observations argue in favour of systematic surgical correction of any aortic arch anomalies in infants, even when they are responsible for few symptoms.

Adult↗