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1.
J Cardiovasc Surg (Torino) ; 56(4): 513-8, 2015 Aug.
Article in English | MEDLINE | ID: mdl-24284938

ABSTRACT

AIM: Circulatory failure following surgery for type A aortic dissection is frequent and associated with a high mortality rate. The intra-aortic balloon pump (IABP) is used to treat postcardiotomy cardiogenic shock but aortic dissection is traditionally a contraindication. In 10 patients we used IABP for severe cardiogenic shock following aortic dissection surgery, here we report on the short and midterm results. METHODS: From January 2000 to April 2008, among 151 patients with type A aortic dissection 10 received a postoperative IABP. False lumen extension was limited to the ascending aorta for 3 patients, reached the arch for 1 and the descending aorta for 6. RESULTS: The device was placed in the operative room (7 patients), intensive care unit (2) and preoperatively (1). IABP was introduced percutaneously except for one who required surgical placement. The mean duration of IABP therapy was 3.8 days. Four patients died, but no death was directly related to IABP. Improvement in hemodynamics allowed 8 patients to be weaned off IABP. None suffered extension of the dissection. Two patients developed IABP-related complications. Six required extrarenal purification. Among the survivors, one died of a stroke at 38 months, 2 recovered the same quality of life and 3 had neurological sequelae without loss of autonomy. CONCLUSION: IABP should only be used as a salvage option in cases of severe cardiogenic shock following type A aortic dissection. No patient suffered device-related aortic rupture or extension of the dissection. High mortality and morbidity underline the gravity of cardiogenic shock in this setting.


Subject(s)
Aortic Aneurysm/surgery , Aortic Dissection/surgery , Intra-Aortic Balloon Pumping , Shock, Cardiogenic/therapy , Vascular Surgical Procedures/adverse effects , Aged , Aged, 80 and over , Aortic Dissection/diagnosis , Aortic Dissection/mortality , Aortic Dissection/physiopathology , Aortic Aneurysm/diagnosis , Aortic Aneurysm/mortality , Aortic Aneurysm/physiopathology , Contraindications , Databases, Factual , Female , Hemodynamics , Humans , Intra-Aortic Balloon Pumping/mortality , Male , Middle Aged , Patient Selection , Recovery of Function , Retrospective Studies , Risk Assessment , Risk Factors , Severity of Illness Index , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/etiology , Shock, Cardiogenic/mortality , Shock, Cardiogenic/physiopathology , Time Factors , Treatment Outcome , Vascular Surgical Procedures/mortality
2.
J Mal Vasc ; 32(2): 83-9, 2007 Apr.
Article in French | MEDLINE | ID: mdl-17329053

ABSTRACT

OBJECTIVES: Endothelial dysfunction is an early event and a critical step in the pathogenesis of systemic sclerosis. Accurate and sensitive tests are needed to correctly assess the degree of microvascular endothelial dysfunction. Spectral analysis of skin blood flow contains a characteristic low frequency reported to be associated with endothelial function in healthy subjects. We hypothesized that the relative amplitude of the oscillation recorded for this low frequency spectrum (0.008 to 0.021 Hz) would be less pronounced in patients with systemic sclerosis than in healthy subjects and in patients with primary Raynaud's phenomenon. PATIENTS AND METHOD: Twenty-one patients with systemic sclerosis, twenty patients with primary Raynaud phenomenon and eleven healthy subjects were enrolled. Skin perfusion was recorded at rest for 30 minutes using laser Doppler flowmetry on the pad of the left third left. Fourier transform spectral analysis was applied to obtain the mean amplitude of the cutaneous blood perfusion signal of the total spectrum from 0.008 to 1.6 Hz and the mean amplitude of each characteristic frequency in the laser Doppler flowmeter blood flow oscillations. RESULTS: The relative amplitudes of each characteristic frequency in the laser Doppler flowmeter blood flow oscillations were not statistically different in the three groups, particularly for frequency spectrum from 0.008 Hz to 0.021 Hz. CONCLUSION: Fourier transform spectral analysis of baseline cutaneous blood flow does not provide significant information. Further studies are required, perhaps using wavelet spectral analysis or stimulated conditions.


Subject(s)
Blood Flow Velocity , Scleroderma, Systemic/physiopathology , Skin/blood supply , Endothelium, Vascular/physiopathology , Female , Humans , Laser-Doppler Flowmetry , Male , Middle Aged , Oscillometry , Pulmonary Fibrosis/epidemiology , Raynaud Disease/epidemiology , Scleroderma, Systemic/diagnosis
3.
Rheumatology (Oxford) ; 45(12): 1490-6, 2006 Dec.
Article in English | MEDLINE | ID: mdl-16705051

ABSTRACT

OBJECTIVES: Thermal hyperaemia is impaired in patients with systemic sclerosis (SSc). The objective of these studies was to determine whether this was consecutive to skin fibrosis, microangiopathy or macroangiopathy. METHODS: Using laser Doppler flowmetry, we first compared the thermal hyperaemia on the third left finger pad and on the left forearm in 21 patients with non-diffuse systemic sclerosis (SSc), in comparison with primary Raynaud's phenomenon and healthy volunteers. Second, we tested whether the altered thermal hyperaemia correlated to the digital pressure index at baseline, and following the thermal challenge. RESULTS: In the first study, thermal hyperaemia of the finger pad was impaired in terms of both amplitude and kinetics, but not on the forearm in patients with SSc. In the seven SSc patients without cutaneous fibrosis, the response was similarly altered in terms of amplitude and kinetics. In the second study, we observed a weak correlation between the digital systolic blood pressure index. However, in the 15 SSc patients tested at 44 degrees C, the median digital systolic blood pressure index was 1.04 (0.84-1.24) at baseline vs 1.08 (0.87-1.29) at 44 degrees C (NS), while seven of them had an abnormal response in terms of kinetic. Furthermore, only one patient showed a clear-cut decrease in digital systolic blood pressure at 44 degrees C. CONCLUSION: In patients with SSc, digital thermal hyperaemia is impaired, but does not relate to the skin fibrosis or to an associated macroangiopathy in most cases. Further studies are required to determine whether its impairment reflects a functional or structural microvascular damage.


Subject(s)
Fingers/blood supply , Hyperemia/etiology , Scleroderma, Systemic/complications , Skin/pathology , Adult , Blood Pressure , Female , Fibrosis/complications , Forearm/blood supply , Hot Temperature , Humans , Hyperemia/physiopathology , Laser-Doppler Flowmetry , Male , Microcirculation , Middle Aged , Raynaud Disease/physiopathology , Scleroderma, Systemic/physiopathology , Vasodilation
4.
Arch Mal Coeur Vaiss ; 99(3): 251-4, 2006 Mar.
Article in French | MEDLINE | ID: mdl-16618030

ABSTRACT

A 48 year old man was admitted to the intensive care unit with septicaemic shock associated with febrile jaundice and anuric renal failure. Within hours, he developed cardiogenic shock with multi-organ failure due to an acute myocarditis refractory to catecholamines and requiring intra-aortic balloon pumping. The diagnosis was an ictero-haemorrhagic leptospirosis, the outcome of which was finally favourable. Myocarditis is an underestimated complication of leptospirosis because it is often symptomless. The main signs are arrhythmias, conduction defects and ST-T wave abnormalities which have little clinical expression. The disease may progress and is sometimes fatal. Leptospirosis myocarditis should therefore be carefully considered because of its potential severity and its reversibility with appropriate antibiotic therapy and also the necessity of initial management in a specific infrastructure.


Subject(s)
Myocarditis/complications , Myocarditis/microbiology , Shock, Cardiogenic/etiology , Weil Disease/diagnosis , Humans , Male , Middle Aged
5.
Rev Mal Respir ; 19(3): 375-7, 2002 Jun.
Article in French | MEDLINE | ID: mdl-12161706

ABSTRACT

The idiopathic hyper-eosinophilic syndrome is defined as a peripheral blood eosinophilia greater than 1.5 x 10(9)/litre present for at least 6 months and associated with visceral involvement. It may only be accepted after carefully excluding the other common or rare causes of hyper-eosinophilia and should remain a diagnosis of exclusion. The associated visceral lesions are multiple and non-specific. Among these neurological, digestive, dermatological and cardiac manifestations are the most frequently described. Whereas pleuro-pulmonary involvement is also common, asthma is rarely reported. We report a case of ideopathic hyper-eosinophilic syndrome presenting as asthma. This was secondary to eosinophilic infiltration of the bronchial mucosa as demonstrated by cytological examination of induced sputum.


Subject(s)
Asthma/etiology , Hypereosinophilic Syndrome/complications , Adult , Humans , Male
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