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Biomedical subjects

Yves Provost

Publications and source records attributed to Yves Provost.

7 recordsLinked to original sources
PubMed2005

True versus false left ventricular aneurysm: differentiation with MR imaging--initial experience.

PURPOSE: To assess the usefulness of cardiac magnetic resonance (MR) imaging for differentiation of true from false left ventricular aneurysm in patients after myocardial infarction. MATERIALS AND METHODS: Cardiac MR images obtained in 22 sequential patients (20 men, two women; mean age, 63 years; age range, 45-75 years) with pathologically proved left ventricular true aneurysm (n = 18) or false aneurysm (n = 4) after myocardial infarction were retrospectively analyzed. The MR imaging protocol included steady-state cine imaging followed by perfusion measurement and delayed contrast-enhanced imaging with delays of 15 and 20 minutes. Differences between true and false aneurysms with regard to maximal internal width of orifice, maximal parallel internal diameter, ratio of maximal orifice to maximal internal diameter, presence of mural thrombus and delayed enhancement of pericardium, left ventricular end-diastolic volume, and left ventricular ejection fraction were analyzed by using the Mann-Whitney U test or Fisher exact test, as appropriate. RESULTS: Inferior wall location was noted in two of four patients with false aneurysm and in none of 18 patients with true aneurysm (P = .03). The remaining aneurysms were apicoanterior (two false, 10 true) or apical (eight true). False aneurysms had a ratio of maximal internal width of the orifice to maximal parallel internal diameter that was significantly lower than that of true aneurysms (0.73 vs 1.00, P < .001) and had a significantly higher left ventricular end-diastolic volume (median, 202 vs 136 mL/m(2); P = .001), as well as a nonsignificant tendency toward lower left ventricular ejection fraction (17% vs 28%, P = .15). Mural thrombus was identified in all four patients with false aneurysm and in seven of 18 patients with true aneurysm (P = .09). Delayed enhancement of pericardium was noted in all four patients with false aneurysm and in three of 18 patients with true aneurysm. Resultant sensitivity of MR imaging for the detection of false left ventricular aneurysm was four of four, specificity was 15 of 18, accuracy was 19 of 22, and positive and negative predictive values were four of seven and 15 of 15 patients, respectively. CONCLUSION: Initial experience with a small number of patients suggests that marked delayed enhancement of the pericardium is a characteristic feature of false aneurysm. Study with a larger patient sample is required to further assess this feature.

Aged↗
PubMed2005

Optimal timing for pulmonary valve replacement in adults after tetralogy of Fallot repair.

The timing of pulmonary valve replacement in adult patients with repaired tetralogy of Fallot remains controversial. A magnetic resonance imaging study in 17 adult patients with repaired tetralogy of Fallot reveals a statistically significant decrease in right ventricular (RV) volume (RV end-diastolic volume 163 +/- 34 to 107 +/- 26 ml/m2, p <0.001; RV end-systolic volume 109 +/- 27 to 69 +/- 22 ml/m2, p <0.001) at a mean follow-up of 21 months after pulmonary valve replacement; whereas RV systolic function remained unchanged (mean RV ejection fraction 32 +/- 7% to 34 +/- 10%, p = 0.12). In no patients with a RV end-diastolic volume >170 ml/m2 or a RV end-systolic volume >85 ml/m2 before pulmonary valve replacement were RV volumes "normalized" after surgery.

Adult↗
PubMed2003

Ventricular reconstruction for ischemic cardiomyopathy.

Left ventricular surgical reconstruction has been advocated for patients with coronary artery disease, prior myocardial infarction, and poor left ventricular function. The objective of the approach is to resect or exclude all akinetic or dyskinetic nonfunctioning portions of the ventricular cavity and to restore the left ventricle size and shape toward normal as much as possible. We review the pathophysiology of ischemic cardiomyopathy and suggest guidelines for preoperative assessment and patient selection for ventricular reconstruction. Because of the prevalence and prognostic significance of ventricular arrhythmias in this patient population we include in our operative approach a visually directed ablation procedure in those with significant septal scarring. We describe our operative technique and review results achieved with this approach. The procedure results in a significant decrease in ventricular volume, increase in ejection fraction and improvement in apical geometry. We conclude that in selected patients with ischemic cardiomyopathy, left ventricular reconstruction can be accomplished with low operative mortality and results in significant improvement in left ventricular function. During follow up symptom class is decreased in most patients and overall survival at 5 years is 84% and freedom from sudden death is 96%. Ventricular reconstruction should be considered in all patients with coronary artery disease and akinetic or dyskinetic scar.

Heart Ventricles↗
PubMedDate not supplied

Radiologic pattern of disease in patients with severe acute respiratory syndrome: the Toronto experience.

Severe acute respiratory syndrome (SARS) is a transmissible febrile respiratory illness caused by a recently discovered coronavirus. Various patterns of disease progression may be observed that have different implications for the prognosis in those affected by SARS. The appearance of the lungs on chest radiographs of patients with this condition may be normal or may include focal airspace opacity or multifocal or diffuse opacities. Thoracic computed tomography (CT) is more sensitive in depicting SARS than is conventional chest radiography, and CT images obtained in patients with normal chest radiographs may show extensive disease and airspace consolidation. However, because the radiologic appearance of SARS is not distinct from that of other diseases that cause lower respiratory tract infection, early identification of SARS will depend in part on the prompt recognition of clusters of cases of febrile respiratory tract illness. To aid in the differential diagnosis and management of SARS, radiologists must be familiar with the typical clinical and histopathologic findings, as well as the radiologic features of the disease.

Adult↗