Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:3.4.16.2 (PCP)
 3,761 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The benefits of surgical correction of mitral incompetence were assessed in 51 patients by comparing pre and postoperative catheter and quantitative angiographic results. The mean age of the patients was 43.5 +/- 12.3 years. The mitral lesions were elongation or ruptured chordae (27 cases), valvular perforation due to endocarditis (1 case) and the usual rheumatic disease in 23 cases. Hemodynamic investigation was carried out on average 2 months before operation and 29 +/- 22 months after surgery. The following angiographic parameters were measured : indexed end diastolic and end systolic volumes (EDV and ESV), ejection fraction (EF), myocardial mass (MM) and its ratio to EDV (hypertrophy coefficient : HC) and the geometry of the ventricle as assessed by diastolic and systolic coefficients of excentricity (DE and SE). Surgery comprised 13 mitral valvuloplasties and 38 valve replacements. Patients who suffered perioperative myocardial infarction or who had a residual valvular lesion were excluded from the study. After surgery, the hemodynamic state was considerably improved with a significant decrease in pulmonary capillary pressures (11 +/- 5 compared to 17 +/- 6 mmHg, p less than 0.09) and mean pulmonary artery pressures (19 +/- 7 compared to 27 +/- 11, p less than 0.01) and increase in cardiac index (2.8 +/- 0.7 compared to 2.3 +/- 0.6 l/min/m2, p less than 0.01). There was an associated decrease in ventricular volumes (EDV : 115 +/- 44 compared to 165 +/- 43, p less than 0.01) (ESV : 60 +/- 39 compared to 77 +/- 22, p less than 0.001). The reduction in myocardial mass was less spectacular (129 +/- 40 compared to 148 +/- 32, p less than 0.01) with a resulting increase in the HC (1.10 +/- 0.26 compared to 0.88 +/- 0.17, p less than 0.001). The geometry of the LV was less spherical in diastole (DE 0.76 +/- 0.08 compared to 0.70 +/- 0.08, p less than 0.001) and in systole (SE = 0.83 +/- 0.06 compared to 0.77 +/- 0.08, p less than 0.001). The EF fell slightly but this was not statistically significant (0.51 +/- 0.13 compared to 0.53 +/- 0.09 NS). The surgical result of 14 patients with PCP greater than or equal to 13 mmHg was considered hemodynamically incomplete, and this was confirmed by a lower cardiac index than in the remaining 37 patients (2.4 +/- 0.5 compared to 3.0 +/- 0.7, p less than 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Hemodynamic and angiographic results following surgical correction of mitral insufficiency. Apropos of 51 repeated catheterizations]. 641 97

A haemodynamic and M mode echocardiographic study of 57 patients hospitalised for chronic, symptomatic 2nd or 2rd degree AV block was carried out after 3 periods of pacing, each lasting 2 hours : 1) sequential AV pacing ( SAV ) with a 200 ms delay, considered as the mode of reference; 2) sequential ventriculo-atrial pacing ( SVA ) with the same sequential delay, recreating equivalent conditions of 1/1 ventriculo-atrial conduction (VAC); 3) ventricular pacing (V) recreating complete AV dissociation ( CAVD ). The pacing rate was the same for each patient (89 +/- 9/min). In comparison with SAV , SVA caused much worse haemodynamic changes than V : large increases in mean atrial pressures (+161% and +64% in RAP and PCP respectively); "canon" atrial A waves which were poorly tolerated (mean amplitude 14 mmHg and 18 mmHg on the RA and PCP waves respectively); in some cases, a large fall in blood pressure was observed due to the failure of systemic resistances to increase and compensate for the constant decrease in pump function (mean reduction of 23% of cardiac index; 29% of LV work index). These changes are much more pronounced in diseased than in healthy hearts, especially in the presence of mitral or tricuspid regurgitation. Echocardiography showed the main cause of these haemodynamic changes to be a reduction in ventricular filling with significant reductions in LV systolic and diastolic dimensions, changes in the mitral valve echos (reduction in the opening and closing velocities, delayed closure), probably related to a decrease in transvalvular blood flow, and decreased regional contractility of the interventricular septum. These observations justify an increase in the indications of modes of pacing maintaining permanent atrio-ventricular sequence (VVI pacing at slow rates; AAI pacing, DVI or DDD pacing in cases of abnormal AV conduction with VAC, especially in cases of sick sinus syndrome with permanent bradycardia). These modes of pacing are particularly beneficial when the electrical abnormality is associated with a decompensated cardiac lesion, or with decreased ventricular compliance or mitral regurgitation.
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PMID:[Hemodynamics and M mode echocardiography of the consequences of ventriculo-atrial conduction in the human]. 642 28

Several studies have shown that mitral valve replacement with total chordal preservation (MVR-TCP) improves left ventricular function when compared with total chordal transection. Few clinical studies, however, have compared this technique to that involving only posterior chordal preservation (MVR-PCP). This study was intended to cover this aspect. A total of 36 consecutive patients with chronic rheumatic mitral incompetence were operated upon by one surgeon and benefited from MVR-TCP (group I). During the same period and along similar selection criteria, 60 patients underwent MVR-PCP (group II) in our department. With the exception of a statistically significant higher preoperative left ventricular ejection fraction (LVEF) percentage and lower fractional shortening (LVFS) percentage in group II patients; both groups were comparable as regarding age, sex distribution New York Heart Association (NYHA) functional class (FC), preoperative left atrial diameter (LAD), left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD) as well as aortic cross-clamp and cardiopulmonary bypass times. The means of the differences, between the pre- and postoperative values of NYHA FC and echocardiographic data were compared between both groups. As compared with group II, group I patients showed lower: hospital mortality rate (0 versus 8.3%; P > 0.05); need for positive inotropic support (11.1 versus 20.8%; P > 0.05) and total ICU stay (2.9 +/- 0.17 versus 2.2 +/- 0.13 days; P < 0.01). In addition, group I patients showed a better NYHA FC improvement (-2.08 +/- 0.15 versus -1.93 +/- 0.11; P > 0.05) as well as a statistically significant (P < 0.00001) higher decrease in the LAD (-18.19 +/- 0.97 versus -11.59 +/- 0.58 mm), LVEDD (-14.44 +/- 0.91 versus -6.17 +/- 0.05 mm), LVESD (-6.17 +/- 0.77 versus -3.23 +/- 0.01 mm), LVFS percentage (-0.06 +/- 0.01 versus -0.01 +/- 0.001%) and a higher increase in the LVEF percentage (8.1 +/- 0.9 versus 1.48 +/- 0.02%). The smaller mean diameter of the implanted St Jude prosthesis, in group I patients (26.77 +/- 0.22 versus 27.43 +/- 0.21 mm; P = 0.046), was neither associated with the use of a smaller prosthesis than that predicted for the patient size nor a significantly higher mean transprosthetic pressure gradient. These data suggest that in rheumatic patients with chronic mitral incompetence, MVR-TCP is always feasible: it is associated with lower hospital mortality and morbidity rates and better preservation of the postoperative left ventricular systolic functions when compared with MVR-PCP.
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PMID:Valve replacement in rheumatic mitral incompetence: total versus posterior chordal preservation. 961 Aug 25