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1.
Ann Cardiol Angeiol (Paris) ; 55(6): 339-41, 2006 Nov.
Article in French | MEDLINE | ID: mdl-17191593

ABSTRACT

The complications of definitive cardiac stimulation must not be forgotten or sub estimate. The aim of our Registry is to compare the complications of the implantation of a pacemaker in the national and international literature. The assessment of our professional practices has been achieved. We suggest improved procedures. The late complications are not exactly known.


Subject(s)
Arrhythmias, Cardiac/surgery , Pacemaker, Artificial , Wound Infection/prevention & control , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Arrhythmias, Cardiac/drug therapy , Asepsis , Humans , Pacemaker, Artificial/adverse effects , Registries , Retrospective Studies , Risk Assessment , Wound Healing
3.
Arch Mal Coeur Vaiss ; 92(9): 1235-8, 1999 Sep.
Article in French | MEDLINE | ID: mdl-10533673

ABSTRACT

The prognosis of patients with coronary artery disease may be threatened by ischaemic mitral regurgitation. Apart from rupture of a papillary muscle which requires rapid valve replacement. Chronic ischaemic papillary muscle dysfunction can often be a severe complication of ischaemic heart disease. The authors report the case of a patient with dyspnoea but no angina of effort. Cardiovascular investigations with right heart catheterisation demonstrated the occurrence of severe mitral regurgitation only during angioplasty of the left marginal artery.


Subject(s)
Angina, Unstable/etiology , Coronary Disease/complications , Mitral Valve Insufficiency/etiology , Myocardial Ischemia/complications , Angina, Unstable/diagnosis , Angina, Unstable/surgery , Angioplasty, Balloon, Coronary , Cardiac Catheterization , Coronary Angiography , Coronary Disease/diagnosis , Coronary Disease/surgery , Echocardiography/methods , Humans , Male , Middle Aged , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/surgery , Myocardial Ischemia/diagnosis , Myocardial Ischemia/surgery , Treatment Outcome , Ultrasonography, Doppler, Color
4.
Circulation ; 94(7): 1519-27, 1996 Oct 01.
Article in English | MEDLINE | ID: mdl-8840839

ABSTRACT

BACKGROUND: Stenting reduces both acute complications of coronary angioplasty and restenosis rates but increases subacute thrombosis rates and hemorrhagic complications when used with coumadin anticoagulation. METHODS AND RESULTS: To simplify postcoronary stenting treatment and to reduce these drawbacks, we evaluated the 1-month outcome of a prospective registry of 2900 patients in whom successful coronary artery stenting was performed without coumadin anticoagulation. Patients received 100 mg/d aspirin and 250 mg/d ticlopidine for 1 month. Low-molecular-weight heparin (LMWH) treatment was progressively reduced in four consecutive stages, from 1-month treatment to none. Event-free outcome at 1 month was achieved in 2816 patients (97.1%). Major stent-related cardiac events were subacute closure in 51 patients (1.8%), including death in 12 (0.5%), acute myocardial infarction in 17 (0.6%), and coronary artery bypass graft surgery in 9 (0.3%). Stent thrombosis was more frequent with balloon size of < 3.0 mm (< or = 2.5 mm, 10%; 3.0 mm, 2.3%; > or = 3.5 mm, 1.0%; P < .001), bail-out situations (6.67% versus 1.38%, P < .001), and patients with unstable angina or acute myocardial infarction (2.2% versus 1.12%, P = .02). Bleeding complications that required transfusion, surgical repair, or both occurred in 55 patients (1.9%). Bleeding complications were related to female gender (4.0% versus 1.51%, P < .001), duration of LMWH treatment (3.83% in phase II/III versus 0.69% in phase IV/V, P < .001), sheath size (6F, 0.52%; 7F, 1.04%; > or = 8F, 4.23%; P < .001), bail-out situations (4.76% versus 1.67%, P < .01), and saphenous graft stenting (4.38% versus 1.75%, P = .04). CONCLUSIONS: These results suggest that poststenting treatment by ticlopidine/aspirin is an effective alternative to coumadin anticoagulation, achieving low rates of subacute closure and bleeding complications. LMWH treatment does not improve subacute reocclusion rates but increases bleeding complications. Furthermore, as bleeding complications were independently related to sheath size, we suggest that stenting with 6F guiding catheters may prevent local complications. Furthermore, the ticlopidine/aspirin combination allows a low-cost stenting strategy without ultrasound assessment of stent deployment and permits short inhospital stay.


Subject(s)
Coronary Vessels , Platelet Aggregation Inhibitors/therapeutic use , Stents , Aged , Anticoagulants/therapeutic use , Aspirin/therapeutic use , Female , France , Hemorrhage/chemically induced , Heparin, Low-Molecular-Weight/adverse effects , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Male , Middle Aged , Prospective Studies , Registries , Stents/adverse effects , Ticlopidine/therapeutic use , Time Factors , Treatment Outcome , Ultrasonics
5.
Arch Mal Coeur Vaiss ; 89(3): 291-7, 1996 Mar.
Article in French | MEDLINE | ID: mdl-8734180

ABSTRACT

This paper reports experience with a new antithrombotic agent prescribed to reduce the incidence of subacute occlusions during the first month after coronary stenting. Therefore, a powerful association of platelet antiaggregant agents was tested. From December 1992 to October 1994, coronary stenting was successfully achieved in 1,294 patients (1,118 men, average age 60.5 +/- 10 years) who were then treated with the association of ticlopidine 0.25 g/day and aspirin 0.10 g/day for one month. This was covered with anticoagulation with a low molecular weight heparin for a variable period (one month, two weeks, then one week), according to the different phases of the study protocol. In all, 1487 stents were successfully implanted (1,330 Palmaz Schatz; 63 Cook; 80 Wictor; 13 AVE and 1 Strecker) in 1,326 vessels (520 left anterior descending, 208 left circumflex, 475 right coronary, 16 left main coronary arteries and 107 venous grafts) using balloon catheters of 2.5 mm to 5 mm diameter for average 3.45 +/- 0.4 mm). Major complications in the first month included 9 deaths (0.7%), 22 occlusions (1.7%): 14 myocardial infarcts (1%) and 11 aorto-coronary bypass procedures (0.85%). There were 136 local haematomas or false aneurysms (10.5%), 42 of which (3.25%) required blood transfusion or surgical repair. This multicenter trial of a protocol associating platelet antiaggregant agents and low molecular weight heparin for one month showed a low incidence of subocclusion after coronary stenting (1.7 +/= 2.5%) and should enable interventional cardiologists to widen the indications for coronary stenting.


Subject(s)
Angioplasty, Balloon, Coronary , Coronary Disease/therapy , Heparin, Low-Molecular-Weight/therapeutic use , Stents , Thrombolytic Therapy , Adult , Aged , Aged, 80 and over , Anticoagulants/therapeutic use , Aspirin/therapeutic use , Drug Therapy, Combination , Female , Follow-Up Studies , Humans , Male , Middle Aged , Platelet Aggregation Inhibitors/therapeutic use , Thrombosis/mortality , Thrombosis/prevention & control , Ticlopidine/therapeutic use , Treatment Outcome
6.
J Am Soc Echocardiogr ; 8(5 Pt 1): 759-61, 1995.
Article in English | MEDLINE | ID: mdl-9417225

ABSTRACT

Systemic embolism is an unusual complication of endoscopic obturation of gastroesophageal varices with glue. This report describes a case of cerebral embolism after this procedure. Intracardiac glue within the left atrium was demonstrated by echocardiography. Cardiac fluoroscopy demonstrated an abnormal vessel connecting periesophageal veins with the right upper pulmonary vein. Cardiac surgery was performed. Intracardiac glue was removed and the entering orifice of the abnormal vessel in the right upper pulmonary vein was sutured. To our knowledge, this is the first reported case of intracardiac glue after variceal obturation. Echocardiography is useful in the diagnosis of this rare complication.


Subject(s)
Echocardiography , Enbucrilate/adverse effects , Esophageal and Gastric Varices/therapy , Foreign Bodies/diagnostic imaging , Heart , Tissue Adhesives/adverse effects , Adult , Esophagoscopy , Esophagus/blood supply , Fluoroscopy , Follow-Up Studies , Foreign Bodies/etiology , Foreign Bodies/surgery , Heart Atria/diagnostic imaging , Humans , Intracranial Embolism and Thrombosis/etiology , Male , Pulmonary Veins/abnormalities , Pulmonary Veins/diagnostic imaging , Pulmonary Veins/surgery , Veins/abnormalities , Veins/surgery
7.
Cathet Cardiovasc Diagn ; 35(1): 1-7, 1995 May.
Article in English | MEDLINE | ID: mdl-7614535

ABSTRACT

In order to simplify post-coronary stenting treatment and to obtain a lower rate of complications, especially in bailout situations, seven French institutions treated 246 stented patients with 0.25 g/day of ticlopidine, 0.1 g/day of IV aspirin, and 2 days of heparin followed by low-molecular-weight heparin for 1 month. Fifty percent of patients had a planned stenting procedure, and 50% had an unplanned procedure, including 29 (11.8%) in bailout situations. Subacute occlusion occurred in three (1.2%) patients (one death, two non-Q-wave infarctions). During the 1 month follow-up period, another death was reported (non-stent-related), two elective coronary artery bypass grafts were performed, and three additional patients presented with non-Q-wave myocardial infarctions. Nine (3.7%) patients had a groin complication that required blood transfusion or surgical repair. These results suggest that while waiting for the technological advancements of stents, postprocedural treatment that includes a low dosage of ticlopidine, aspirin, and low-molecular-weight heparin is a very effective alternative to conventional poststenting therapy.


Subject(s)
Angioplasty, Balloon, Coronary , Aspirin/therapeutic use , Heparin, Low-Molecular-Weight/therapeutic use , Stents , Thrombosis/prevention & control , Ticlopidine/therapeutic use , Adult , Aged , Aged, 80 and over , Coronary Disease/therapy , Drug Therapy, Combination , Electrocardiography , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Thrombosis/mortality
8.
Arch Mal Coeur Vaiss ; 84 Spec No 3: 89-94, 1991 Sep.
Article in French | MEDLINE | ID: mdl-1953291

ABSTRACT

The measurement of pulse wave velocity (PWV) is one of the oldest methods of evaluating the dynamic properties of the arterial wall and also one of the most simple. Its value has been proven clinically by epidemiological studies as its value is directly related to changes in arterial structure with aging and hypertension. However, clinical measurement of PWV is an indirect method, and although simple in theory it may provide diverging results because of the large number of structural and functional parameters which influence the transmission of the pressure wave. This explains the difficulties encountered in determining a representative reference value for PWV. Nevertheless, for interpretation of the results, the data provided by PWV measurement about arterial distensibility underline the importance in all measurements of arterial compliance of taking into account the site and conditions of measurement in order to evaluate the variability and physiological role of the arterial segment under study.


Subject(s)
Arteries/physiology , Age Factors , Blood Flow Velocity , Compliance , Humans , Muscle, Smooth, Vascular/physiology , Physical Exertion , Pulsatile Flow , Reproducibility of Results , Rest
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