Showing papers by "Etienne Aliot published in 1993"

Noninvasive assessment of coronary flow dynamics before and after coronary angioplasty using transesophageal Doppler

Abstract: Recent invasive studies using intracoronary Doppler catheters or guide wires reported improved coronary flow dynamics after successful percutaneous transluminal coronary angioplasty. Transesophageal Doppler enables the measurement of coronary flow velocities within the left anterior descending artery. The present study was designed to test: (1) whether transesophageal Doppler may detect coronary flow velocity changes in patients undergoing angioplasty for left anterior descending artery stenosis, and (2) whether this technique may help to evaluate non-invasively the results of the procedure. Twenty-three patients undergoing angioplasty of the left anterior descending artery were studied by transesophageal Doppler before and ≤24 hours after the interventional procedure. Coronary flow velocities were measured in the proximal part of the left anterior descending artery with the use of pulsed Doppler guided by color flow imaging. The degree of stenosis was measured by computerized quantitative coronary arteriography. Coronary flow velocity signals were successfully obtained in 19 of 23 patients (83%). In 16 successful angioplasty procedures, peak diastolic velocity increased from 37 ± 14 cm/s before angioplasty to 51 ± 16 cm/s after (p = 0.0001). In the 3 patients in whom angioplasty was unsuccessful, transesophageal Doppler showed no significant increase in peak diastolic coronary flow velocity. In a total of 19 angioplasty procedures, a good linear relation was found between the percent changes in coronary flow diastolic velocity and the reduction in the degree of stenosis (r = 0.85; p = 0.0001). All patients with >20% increase in peak diastolic velocity had >40% stenosis reduction. Thus, in patients with stenosis of the left anterior descending artery, transesophageal Doppler shows improvement in coronary flow pattern after successful angioplasty. This method may be useful for noninvasive evaluation of angioplasty results in these patients.

Primary ventricular fibrillation

Abstract: In the absence of autopsy studies, the etiological diagnosis of this form of ventricular fibrillation (VF) depends on the exclusion of cardiac disease by all available invasive and non-invasive diagnostic methods. Primary VF is rare and affects young adults. There are few clinical markers and published electrophysiological data indicates that sustained ventricular tachycardia or VF is unlikely to be induced by programmed ventricular stimulation. The underlying mechanism of the arrhythmia is poorly understood. However, a possible arrhythmogenic substrate has been suggested in small zones of fibrosis within normal Purkinje tissues, as encountered in some minor forms of arrhythmogenic right ventricular dysplasia. Also, the role played by the autonomic nervous system in triggering VF seems to be particularly important. Some described cases resemble curiously "torsades de pointes" with a short coupling interval. The "cardiac" prognosis of resuscitated patients is usually good. However, arrhythmic recurrences are common, and, classically, antiarrhythmic drugs are usually ineffective. The indication for implantation of an automatic defibrillator is therefore justified in patients surviving primary VF. The lack of understanding of this condition is an argument in favour of setting up a French register of patients with primary VF in order to establish its clinical features.

Implantable defibrillator using epicardial and endocardial leads. Results of 36 implantations

Abstract: Les auteurs rapportent leur experience du defibrillateur implantable apres 5 ans d'utilisation. Entre fevrier 1988 et juillet 1992, 36 patients (25 hommes, 11 femmes, âge moyen: 51±11 ans, extremes: 18 et 71) ont beneficie de l'implantation d'un defibrillateur par voie epicardique (n=13, groupe I) et endocardique (n=23, groupe II) sans patch associe (n=7), avec patch sous-cutane (n=12) ou epicardique (n=4). Trois complications precoces graves ont ete observees: 2 chocs cardiogeniques dans le groupe I dont un deces a J1 et une infection imposant une explantation du boitier a J23 dans le groupe II