Archives des maladies du coeur et des vaisseaux
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Arch Mal Coeur Vaiss · Jul 1998
Comparative Study[The value of transesophageal echocardiography for the diagnosis of pulmonary embolism with acute pulmonary heart disease].
Transoesophageal echocardiography is a method of visualising intracardiac thrombi and could therefore be useful for the diagnosis of pulmonary embolism, but its diagnostic value is unknown. The authors carried out a prospective study with this diagnostic tool in massive pulmonary embolism. The study protocol was to perform transthoracic echocardiography in patients with suspected acute pulmonary embolism and then to perform transoesophageal echocardiography when there were signs of acute cor pulmonale. ⋯ In acute cor pulmonale, the diagnostic value of transoesophageal echocardiography is poor because the sensitivity for visualisation of intra-pulmonary arterial thrombi is low compared with other radiological techniques. However, in patients with proximal emboli in the right or main pulmonary artery, the diagnosis may be established in a few minutes without the need of other more invasive techniques. Nevertheless, normal transoesophageal echocardiography does not rule out the presence of proximal in the left pulmonary artery or distal emboli in the lobar arteries.
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Arch Mal Coeur Vaiss · Jul 1998
[Coronary surgery on the beating heart under extracorporeal circulation in high-risk patients. An acceptable compromise?].
Coronary artery surgery with cardioplegia in high risk patients carries a risk of myocardial ischaemia and, without cardiopulmonary bypass, is not always technically feasible. The authors assessed an alternative, surgery on the beating heart with haemodynamic assist by cardiopulmonary bypass in 43 consecutive patients with poor left ventricular function (mean ejection fraction: 0.26), evolving myocardial ischaemia or acute myocardial infarction, old age (mean: 79.5 years) and comorbid conditions. Results were assessed mainly on clinical criteria. ⋯ On the other hand, the minimal concentrations of mediators of inflammation were not significantly changed. In selected high risk patients, coronary revascularisation on the beating heart under cardiopulmonary bypass could be a valuable alternative. It conserves the potentially deleterious effects of cardiopulmonary bypass but peroperative global myocardial ischaemia, an important factor in the aggressivity of cardiac surgery, is eliminated.