Archives des maladies du coeur et des vaisseaux
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Arch Mal Coeur Vaiss · Nov 1995
[Pulmonary embolectomy in pulmonary embolism: surgery and endoluminal techniques].
Since Trendelenburg's first attempts in 1908, the techniques of embolectomy have progressed considerably. The reference method remains embolectomy under cardiopulmonary bypass, the development of which has reduced the operative mortality to 30-40% instead of 60% when embolectomy was performed without cardiopulmonary bypass. ⋯ These procedures are difficult to initiate, little experimented in humans or still at the experimental stage in animals. Advances in the medical treatment of massive acute pulmonary embolism have reduced the indications of embolectomy which has become the exception reserved for the most seriously ill patients in whom the other methods are contraindicated or have failed.
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Arch Mal Coeur Vaiss · Nov 1995
Review[Indications of partial interruption of the inferior vena cava in pulmonary embolism].
Forty years after the first implantation of caval filters, there is still no indication for implantation validated by a controlled clinical trial. This fact may be explained by our poor understanding of the evolution of thromboembolic disease, especially in certain groups of patients. The absolute contra-indications to heparin therapy would seem to be a logical indication for a caval filter. ⋯ The implantation of a filter would seem to be justified in patients with chronic cor pulmonale after pulmonary embolectomy. The value of a temporary caval filter during thrombolysis has not been demonstrated; there are hopes that temporary filters "of long duration" will provide filtration of the vena cava during vulnerable periods. The results of the first controlled trial (PREPIC) are eagerly awaited and should rationalise the indications of inferior vena cava filters.
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In general, there are two types of right heart thrombi diagnosed by echocardiography: mobile and non-mobile thrombi, more often located in the atrium than in the ventricle and a potential source of pulmonary embolism. However, they differ in several points: clinical context, clinical and echocardiographic presentations, embolic potential, prognosis and treatment. The result of peripheral venous thrombosis, mobile thrombus it is usually diagnosed during echocardiographic investigation of pulmonary embolism. ⋯ It decreases or disappears with anticoagulant therapy and the outcome is usually good. The differential diagnosis between a mobile thrombus and a Chiari network, or between an adherent thrombus and a vegetation on a intracardiac pacing wire may be difficult and requires transoesophageal echocardiography. The investigation of pulmonary embolism requires systematic echocardiography, one of the objectives of which is to search for right sided thrombi.
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Arch Mal Coeur Vaiss · Aug 1995
Comparative Study[Hormonal contribution to short-term variability of blood pressure in a renovascular hypertension model].
Spectral analysis was recently chosen to characterize the fast oscillations depending on the autonomic nervous system. Humoral stimuli could impinge on low frequency (LF) domain of blood pressure (BP) since the time lag to humoral systems activation is larger. This study was designed to analyse LF components of short-term variability of BP of conscious rats in conditions where humoral systems were activated. ⋯ After the combined blockade, the LF component of SBP of the hypertensive rats was equivalent to that of the sham rats. Thus, an increase in the LF component of BP variability was observed in a model of hypertension where the BP is dependent upon humoral factors. The contribution of the renin-angiotensin and kallikrein-kinin systems in the slow fluctuations of BP was demonstrated using two specific antagonists losartan and Hoe 140.