Archives des maladies du coeur et des vaisseaux
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Arch Mal Coeur Vaiss · Mar 1990
Case Reports[Floating left atrial thrombus in 2 cases of severe mitral stenosis].
The authors report two operated cases of floating left atrial thrombus. Both patients had severe mitral stenosis, atrial fibrillation and dilatation of the left atrium. ⋯ The diagnosis was made in both cases by two-dimensional echocardiography which, in addition to confirming the severe mitral stenosis, showed a round, free-floating intra-atrial mass, rebounding from wall to wall and repeatedly engaging itself into the mitral orifice. The risk of prolonged engagement of the thrombus in the mitral orifice, causing syncope or sudden death, justifies urgent surgery associating thrombectomy and treatment of mitral stenosis every time this problem is encountered.
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Arch Mal Coeur Vaiss · Mar 1990
Case Reports[Refractory arterial hypoxemia and interatrial right-left shunt in myocardial infarction of the right ventricle].
The authors report the case of a 63 year old woman who developed refractory arterial hypoxemia due to a right-to-left interatrial shunt through a patent foramen ovale during the acute phase of right ventricular infarction. The precarious haemodynamic condition of the patient contra-indicated surgical intervention and so the effects of the shunt were reduced by obstructing the atrial septal defect with the balloon of a Swan-Ganz catheter. The management of this type of shunt is discussed based on the degree of hypoxemia and the patient's haemodynamic status with reference to this particular case and a review of the literature.
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Arch Mal Coeur Vaiss · Feb 1990
Randomized Controlled Trial Multicenter Study Clinical Trial[Study of survival using anistreplase (Eminase)].
Thrombolytic therapy has been one of the most important advances in the field of cardiovascular medicine. Several agents are available and research is continuing to develop new effective thrombolytics with a rapid onset of action. ⋯ Survival is certainly the parameter of choice for assessing any thrombolytic protocol. The aim of this paper is therefore to review the results of survival studies with Eminase, one of the new thrombolytic agents used in the treatment of acute myocardial infarction.
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Anistreplase is a second generation thrombolytic agent, an equimolecular streptokinase lys-plasminogen complex the active site of which is temporarily blocked by a p-anisoyle group. Acylation enables the drug to be administered as a bolus intravenous injection over 2 to 5 minutes, and it protects anistreplase against circulating inhibitors, hence a plasma elimination half-life of 90 minutes. Deacylation is slow and progressive (deacylation half-life: 105 minutes), and it begins as soon as the product is injected. ⋯ In vitro studies have shown that the affinity of anistreplase for fibrin is similar to that of t-PA. In doses used for myocardial infarction, anistreplase induces a pronounced fibrinogenolysis. The effectiveness of the drug has been demonstrated on numerous animal models and subsequently by clinical trials.
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Arch Mal Coeur Vaiss · Feb 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Effects of anistreplase on coronary patency in acute myocardial infarction].
Anistreplase or APSAC (anisoylated lys-plasminogen streptokinase activator complex) is a new, third generation thrombolytic agent with a long (90 minutes) elimination half-life, so that it can be administered by bolus intravenous injection over 2 to 5 minutes. In acute myocardial infarction anistreplase in doses of 30 units gives a coronary recanalisation rate of about 65 per cent and an early coronary patency rate of about 80 per cent. ⋯ The time required for recanalisation to occur is short (25 to 45 minutes depending on the time elapsed before administration), and the early (24 hours) coronary reocclusion rate is low (about 5%). These results, together with the ease of administration of the drug, could make anistreplase the first-choice thrombolytic agent in the treatment of recent myocardial infarction, notably in general hospitals and mobile intensive care units.