Archives des maladies du coeur et des vaisseaux
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Arch Mal Coeur Vaiss · Sep 1994
Comparative Study[Vaso-reactive properties of radial and internal mammary arteries: application to coronary bypass surgery].
Satisfactory results were obtained with the radial artery used as a conduit for coronary artery bypass. However, spasm of this conduit was observed. Human radial and internal mammary artery ring segments were studied in organ chambers. ⋯ The radial artery presents stronger contractions than the internal mammary artery. The two vessels have equal sensitivity to the vasoconstrictors used. These data emphasize the hyperreactivity of the radial artery and the need for prevention of vasospasm when this vessel is used as a conduit for coronary artery bypass.
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Arch Mal Coeur Vaiss · Jun 1994
Case Reports[Paradoxical embolism of the aortic arch diagnosed by transesophageal echocardiography. Surgical treatment].
The authors report the case of a woman who presented with a pulmonary embolism followed by systemic embolism. Transoesophageal echocardiography showed a persistent foramen ovale compatible with a possible paradoxical embolism. ⋯ This embolism was extracted under cardiopulmonary bypass to avoid a recurrence of embolism. Transoesophageal echocardiography is the only reliable, non-invasive method allowing simultaneous diagnosis of a right to left shunt and visualisation of the thoracic aorta.
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Arch Mal Coeur Vaiss · Apr 1994
Case Reports[Partial pulmonary embolectomy without extracorporeal circulation. Apropos of a case].
The authors report a case of massive pulmonary embolism compromising the haemodynamic status of a 52 year old man with a formal contraindication to thrombolytic therapy. Unilateral pulmonary embolectomy was performed without cardiac pulmonary bypass, preceded by partial interruption of the inferior vena cava. Postoperative controls confirmed the success of the surgical procedure. Although the indications of surgical embolectomy are limited, especially without cardiopulmonary bypass, it may be considered for the treatment of certain cases of massive pulmonary embolism.
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Arch Mal Coeur Vaiss · Apr 1994
[Inferior wall myocardial infarction and atrioventricular block; angiography and prognosis].
This study was based on 42 cases of 2nd or 3rd degree atrioventricular block out of 292 cases of inferior wall myocardial infarction. The criteria of selection were monitoring in the intensive care unit during the acute phase, selective coronary angiography in the first 48 hours to 5 days, and regular clinical follow-up during the first year after infarction. The conduction defect was either immediately recorded on the first ECG, delayed (between the 12th and 24th hour) or late (after the 3rd day). These 42 inferior wall infarcts with atrioventricular block (incomplete in 14 and complete in 28 cases) differed from inferior infarction without block by: - the severity of the clinical signs during the acute phase (35% with cardiac failure, 19% with cardiogenic shock); - the severity of the coronary lesions (71.4% with triple vessel disease in infarction with atrioventricular block compared with 32% in those without block, p < 0.02); - the prevalence of the association of > 70% stenosis of the right coronary and left anterior descending arteries; - the alteration of left ventricular function (53% patients with atrioventricular block had ejection fraction of under 30%); - the severity of these infarcts was not related to the atrioventricular block which regressed in 95% of cases but to the severity of the coronary disease, the left ventricular dysfunction and the advanced age of the patients (72.3 +/- 8 years).
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Arch Mal Coeur Vaiss · Jan 1994
Comparative Study[Continuous monitoring of cardiac output by analysis of the pulse contour].
One method of continuous cardiac output monitoring by analysis of the radial pulse contour (Qcp) relates left ventricular stroke volume and systolic blood pressure by calculating the impedence characteristic of the aorta (Zao). It was assessed during haemodynamic monitoring by comparing it with the thermodilation method in the pulmonary artery (Qtd) in 20 patients with cardiac failure due to dilated cardiomyopathy (6 cases) and ischaemic cardiomyopathy (14 cases) treated by inotropic agents or vasodilators. Over an average monitoring period of 35 hours 159 measurements of cardiac output were performed by the two methods. ⋯ The accuracy of Qcp compared with Qtd was 12.5%. During infusion with a vasoactive agent (Piroximone), the method based on pulse contour analysis did not reflect sudden variations in cardiac output. The systematic error between the two methods rose to 19% of the value measured, reflecting the lack of adaptation of parameters of correction in this situation and which necessitated recalibration of Zao at least once after injection of the drug.