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Biomedical subjects

Y Taeymans

Publications and source records attributed to Y Taeymans.

At least 37 records · Page 2Linked to original sources
PubMed1998

Entrapment of a guide wire during percutaneous occlusion of a coronary artery fistula.

Coronary artery fistulas are extremely rare and coil occlusion by intervention techniques seems to be the therapy of choice. We describe the case of a 3-month-old infant with a coronary artery fistula. During occlusion of the fistula a coronary guide wire got entrapped in a small coronary branch, but could be successfully retrieved with a microsnare without damage to the heart. The microsnare technique prevented rupture of the guide wire.

Angioplasty, Balloon, Coronary↗
PubMed1997

Recanalization of total coronary occlusions using a laser guidewire (the European TOTAL Surveillance Study).

The success rates of coronary angioplasty for the treatment of chronic total occlusions are less favorable than for coronary stenosis. Therefore, a new laser guidewire (LW) was designed to facilitate the crossing of chronic total occlusions. We report on the results of a European multicenter surveillance study, evaluating the laser guidewire performance. Between May 1994 and July 1996, 345 patients (age 59 +/- 10 years, 291 men) with chronic total occlusions were enrolled in 28 European centers. The median age of occlusion was 29 weeks (range 2 to 884), the occlusion length 19 +/- 10 mm. LW recanalization was successful in 205 patients (59%/). LW perforation occurred in 73 patients (21%), with hemodynamic consequences in 4 (1%). There were no deaths, emergency coronary artery bypass graft surgery, or Q-wave myocardial infarctions. In a multivariate regression analysis an occlusion age of <40 weeks (p = 0.001, RR = 1.34) and an occlusion length <30 mm (p = 0.01, RR = 1.59) were independent predictors of success. Results indicate that the LW is an effective and safe tool in the treatment of chronic total occlusion refractory to conventional guidewires.

Chronic Disease↗
PubMed1997

Hufnagel procedure reconverted by endovascular leaflet dislocation and extirpation.

Before the development of standard aortic valve replacement, Hufnagel treated aortic insufficiency by implanting a ball-valve prosthesis in the descending thoracic aorta. In a patient who, after four major thoracic procedures, ultimately received two mechanical bileaflet valves in series (one in the ascending and one in the descending aorta), the downstream prosthesis became progressively immobilized, with total blockage of the leaflets in the open position due to insufficient transvalvular negative pressure gradient. After evaluation of this particular situation in an experimental model, we predicted blockage of the downstream prosthesis, once the ascending valve had regained normal function, and easily cleared the blockage of the distal valve by removing the two leaflets using balloon inflation. Normal circulation was clinically restored in three separate steps. (a) Normal function was re-established surgically in the ascending aorta position. (b) A second thoracotomy was avoided by endovascular dislocation of both blocked descending thoracic leaflets through endovascular balloon inflation. (c) Both leaflets embolized to the level of the left common iliac artery, where the nearly intact leaflets were removed surgically, finally creating a near-normal circulatory situation.

Aorta, Thoracic↗
PubMed1996

Cardiorespiratory variables during a continuous ramp exercise protocol in normal young adults.

The purpose of the present study was to determine whether the cardiorespiratory variables measured during an exercise test with a continuously increasing workload (ramp) protocol are reproducible and to compare them to the values obtained with a step-wise incremental (James) protocol. Twenty normal adolescents and young adults performed two exercise tests on a cycle-ergometer, one with each protocol, and twelve of these subjects additionally performed a second identical ramp test. The results show that the cardiorespiratory variables measured during exercise with ramp protocol are reproducible and that peak values are not different from those obtained with step-wise incremental exercise protocol, except for a higher peak power. At intermediate equivalent workloads, there were significant correlations between cardiorespiratory variables measured in steady-state conditions with the incremental protocol and those obtained in non-steady-state conditions with the ramp protocol.

Adolescent↗
PubMed1995

Echocardiography of sinus of Valsalva aneurysm with rupture into the right atrium.

Before the advent of modern techniques, diagnosing unruptured sinus of Valsalva aneurysm in the living patient was rare, with most of the reports coming from autopsy or surgery. Once rupture occurs however, characteristic symptoms and signs, such as precordial distress, a continuous murmur over the base of the heart, pulmonary congestion, and congestive heart failure, usually occur rather abruptly. We describe a case of ruptured aneurysm of the non-coronary sinus of Valsalva diagnosed by transthoracic echocardiography and Doppler as a single examination for quickly establishing a correct diagnosis in patients with a new continuous murmur.

Aged↗
PubMed1995

Tricuspid valve replacement: postoperative and long-term results.

A series of 146 consecutive patients who underwent tricuspid valve replacement at the University Brugmann Hospital between 1967 and 1987 was reviewed. Mean age at operation was 51.4 years (+/- 12.1 years). Different types of prostheses were implanted including porcine and bovine pericardial bioprostheses and older and bileaflet mechanical valves. Most patients were severely disabled by their cardiac disease before operation, with 30.1% in New York Heart Association functional class III and 69.9% in class IV. Operative mortality and hospital mortality rates (30 days) were high (16.4%). Incremental risk factors for hospital death included icterus (p < 0.005), preoperative hepatomegaly (p = 0.012), and New York Heart Association functional class IV (p = 0.013). Multivariate analysis only selected preoperative icterus (p < 0.01) as being independently significantly related to hospital mortality. The hospital survivors were followed up for a median of 94 months. A complete follow-up was available for all patients except two for 30 months or more. At 30 months the only two significant parameters were the type of myocardial protection (p = 0.024) and the year of operation (before 1977 or after [precardioplegia era or after], p = 0.011). There were 70 late deaths during the entire follow-up period. The univariate (log-rank statistics) incremental risk factor for late death was the type of tricuspid prosthesis (Smeloff-Cutter and Kay-Shiley versus St. Jude Medical versus bioprosthesis) (p = 0.04). A trend was observed for the type of operative myocardial protection (normothermia and coronary perfusion) (p = 0.06) and preoperative New York Heart Association functional class IV (p = 0.055). Actuarial survival was 74% at 60 months and 23.4% at 180 months. Cumulative follow-up added up to 1015 patient-years. In a more detailed analysis of the effect on survival of the type of tricuspid prosthesis, a significant difference was observed between the bioprostheses and some older mechanical prostheses (Smeloff-Cutter and Kay-Shiley) (p = 0.04) but not between the bioprostheses and the bileaflet valves (p = 0.15). When the follow-up period was stratified according to less than 7 years and more than 7 years of follow-up, no difference was observed for the first period, but for the late follow-up the new mechanical prostheses did better than the bioprostheses (p = 0.05), suggesting a degradation of the bioprostheses after 7 years and favoring mechanical prostheses for those patients with a good long-term prognosis.

Actuarial Analysis↗
PubMed1995

The valve choice in tricuspid valve replacement: 25 years of experience.

This study reviews 146 consecutive patients who underwent tricuspid valve replacement (TVR) with 69 bioprostheses (porcine and bovine pericardial) and 77 mechanical ball, disc or bileaflet valves between 1967 and 1987. The mean age was 51.4 +/- 12.1 years. Preoperatively, 97% were in New York Heart Association (NYHA) functional class III or more and over 40% had undergone previous cardiac surgery. Hospital mortality was high (16.1%). Incremental risk factors for hospital death were preoperative icterus (P < 0.01), hepatomegaly (P = 0.02), NYHA functional class IV (P = 0.02) and male sex (P = 0.04) (univariate analysis). Ninety-eight percent of the hospital survivors were followed up for a mean of 92 months. Cumulative follow-up added up to 955 patient-years. There were 70 late deaths. The actuarial survival rate was 74% at 60 months and less than 25% at 14 years. Incremental risk factors for late death indicated by univariate analysis were the type of tricuspid prosthesis (Smel-off-Cutter and Kay-Shiley prostheses) (P = 0.04), the type of operative myocardial protection (normothermia and coronary perfusion) (P = 0.05) and preoperative NYHA functional class IV (P = 0.05). We conclude that TVR carries a high operative risk and poor long-term survival, both influenced by preoperative and perioperative variables. Bearing in mind the poor prognosis for TVR, we prefer a large-sized bioprosthesis, in view of its initial good durability and low risk of valve-related events. However, in patients with good life expectancy, a bileaflet mechanical prosthesis may be an acceptable alternative.

Actuarial Analysis↗
PubMed1994

Transcatheter treatment of angina after coronary surgery due to concomitant internal mammary steal and right coronary artery stenosis: a need for staging.

Unligated side branches of the internal mammary artery used as a conduit in bypass surgery can be responsible for a flow steal phenomenon, causing recurrent angina. In this report we describe such a case, which was treated with a transcatheter embolization technique using coils as an alternative to surgery. However, heparin administration for simultaneous balloon dilatation of another lesion delayed successful embolization. Whenever balloon dilatation and embolization have to be performed on the same patient, both procedures should be staged to avoid heparin administration during and after the embolization procedure.

Angina, Unstable↗
PubMed1993

Aortobronchial fistula: a late complication of coarctation repair by patch aortoplasty.

A case of aortobronchial fistula occurring 13 years after coarctation repair by patch aortoplasty is presented. Correct diagnosis was established by computed tomographic scanning and magnetic resonance imaging. Surgical treatment consisted of simple closure of the bronchial defect and interposition of a Dacron graft under partial extracorporeal bypass.

Adult↗
PubMed1993

Magnetic resonance imaging in tracheal compression by the innominate artery.

Tracheal compression by the innominate artery is frequently suspected in infants with noisy breathing and no obvious aortic arch anomalies or pulmonary artery sling. However the diagnosis is difficult to confirm. The findings after using magnetic resonance imaging in two infants with tracheal compression syndrome are presented.

Brachiocephalic Trunk↗
PubMed1992

Quantitative angiographic morphology of the coronary artery lesions at risk of thrombotic occlusion.

BACKGROUND: Coronary angiography in acute myocardial infarction has revealed complicated atherosclerotic plaque and a high rate of thrombotic occlusion. However, the characteristics of lesions at high risk of subsequent occlusion are not well known. METHODS AND RESULTS: In the present study, the qualitative and quantitative angiographic features of 38 coronary artery lesions that occluded within 3 years to cause an acute myocardial infarction were compared with 64 control segments from the same patients that did not occlude. Compared with control lesions, the lesions that occluded were more likely to have a division branch originating within the stenosis (76% versus 52%, p less than 0.05). The percent lumen diameter reduction was more severe (47.5 +/- 17.8% versus 41 +/- 12.5%, p less than 0.05) and the inflow (21 +/- 10 degrees versus 16 +/- 7 degrees, p less than 0.05) and outflow (20 +/- 10 degrees versus 16 +/- 8 degrees, p less than 0.05) angles of the stenosis were steeper. Time to myocardial infarction after the angiogram interacted with the importance of these features (p less than 0.02). Thus, paired analysis of the lesions that occluded within 3 months and of the most severe control lesion from each patient showed percent lumen diameter reduction of 62.1 +/- 11.5% and 46.4 +/- 11.4%, respectively (p less than 0.001). The length of the stenosis, its asymmetry, and the irregularity of the contours did not help differentiate occlusive from control segments. CONCLUSIONS: Coronary artery lesions at high risk of thrombotic occlusion share common characteristics that favor higher shear stress and flow separation.

Adult↗
PubMed1990

Detection of late potentials on the averaged QRS signal recorded at rest and during a standardized stress test after acute myocardial infarction.

The high-amplification signal-averaged ECG (SAECG) allows the detection and analysis of late potentials (LP), which are related to a higher risk of severe ventricular arrhythmias in patients with myocardial disease and coronary artery disease. Because of excessive noise, this technique is usually performed at rest and occasionally immediately after interruption of exercise. Until now, however, it has not been used during exercise. The authors relate in this paper the method and results of the SAECG recorded at rest and during a standard stress test on 30 patients with a recent first myocardial infarction (day 10-14), in good condition, without ECG evidence of significant residual ischemia or bundle branch block. The SAECG was recorded during the steady state of a standardized stress test when a heart rate (HR) corresponding to 80% of the maximal HR was reached during a first test. Three patients had three criteria for LP, three others had two criteria, and two had only one. It has been impossible to analyze the SAECG during exercise because of excessive noise. One patient out of 30 in our study, 21 subjects had normal SAECG at rest and during exercise. None of the 6 patients with more than 1 abnormal criterion at rest became normal during the stress test despite a decrease of the duration criteria in all and an increase of the amplitude (root mean square) the terminal 40 ms (RMS40), as opposed to the 2 patients with just one positive criterion at rest (RMS 40 less than 25 muV) who became normal during exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Arrhythmias, Cardiac↗
PubMed1989

Echocardiography and magnetic resonance imaging in cardiac amyloidosis.

Cardiac amyloidosis is an uncommon cause of heart failure. Based on an observation of immunocytic cardiac amyloidosis with a fatal course, the diagnostic modalities are reviewed with special emphasis on echocardiographic findings. The possible role of magnetic resonance imaging is discussed.

Amyloidosis↗
PubMed1987

Treatment of malignant pericardial tamponade with sclerosis induced by instillation of bleomycin.

Five patients with pericardial tamponade of neoplastic origin were treated by pericardiocentesis, drainage and local instillation of bleomycin. The pericardial effusion was adequately controlled in all patients. Survival was influenced not by the pericardial involvement, but by the natural evolution of the tumour. Side effects were minimal. The technique of drainage and bleomycin sclerosis is simple, safe, effective and inexpensive for the management of a malignant pericardial tamponade, providing all precautions necessary for diagnosis and pericardiocentesis are adequately taken.

Aged↗
PubMed1987

Assessment of left ventricular function in a randomised study of intravenous anisoylated plasminogen streptokinase activator complex versus heparin in acute myocardial infarction. Preliminary results of the European Multicentre Study (Belgian Centres).

Patients admitted within 4 hours of the onset of chest pain suggestive of acute myocardial infarction were randomised to either intravenous anisoylated plasminogen streptokinase activator complex (APSAC) 30U or heparin 5000U (44 vs 38 patients). Angiograms were obtained between days 10 and 15 after admission. Late coronary patency was recorded in a significantly higher proportion of patients in the APSAC group (79% vs 42%, p less than 0.001). The global ejection fraction showed only a favourable trend: 55.3 +/- 12% for the APSAC group vs 54.1 +/- 13.1% for the heparin group; this trend was only observed in the inferior infarction group. Regional wall motion analysis did not show any significant difference between treatment groups.

Anistreplase↗
PubMed1987

Effect of carvedilol on ambulatory blood pressure, renal hemodynamics, and cardiac function in essential hypertension.

A randomized, double-blind, placebo-controlled study was set up to study the effects of acute and chronic administration of carvedilol, a vasodilatory beta-blocker in essential hypertension. Acute administration of a single dose of 50 mg of carvedilol reduced systolic and diastolic blood pressure, without inducing reflex tachycardia. Renal blood flow was preserved; accordingly renal vascular resistance was significantly reduced. A significant reduction of glomerular filtration rate and filtration fraction was observed. Plasma renin activity (PRA) and plasma aldosterone were not changed. Chronic carvedilol treatment produced a significant fall in systolic and diastolic office and ambulatory blood pressure, heart rate, cardiac output, PRA and plasma aldosterone. Blood pressure variability was not changed. Renal blood flow, glomerular filtration rate and filtration fraction also remained unchanged; renal vascular resistance decreased significantly. It is concluded that carvedilol possesses definite antihypertensive and renal vasodilating properties, both acutely and after chronic treatment.

Adrenergic beta-Antagonists↗