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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

One method of continuous cardiac output monitoring by analysis of the radial pulse contour (Qcp) relates left ventricular stroke volume and systolic blood pressure by calculating the impedence characteristic of the aorta (Zao). It was assessed during haemodynamic monitoring by comparing it with the thermodilation method in the pulmonary artery (Qtd) in 20 patients with cardiac failure due to dilated cardiomyopathy (6 cases) and ischaemic cardiomyopathy (14 cases) treated by inotropic agents or vasodilators. Over an average monitoring period of 35 hours 159 measurements of cardiac output were performed by the two methods. There was an excellent correlation between the two methods (r = 0.90; p < 0.001; Qcp = 0.97 Qtd). The systematic error (bias) between the two methods was about 2.5%. The accuracy of Qcp compared with Qtd was 12.5%. During infusion with a vasoactive agent (Piroximone), the method based on pulse contour analysis did not reflect sudden variations in cardiac output. The systematic error between the two methods rose to 19% of the value measured, reflecting the lack of adaptation of parameters of correction in this situation and which necessitated recalibration of Zao at least once after injection of the drug.
Arch Mal Coeur Vaiss 1994 Jan
PMID:[Continuous monitoring of cardiac output by analysis of the pulse contour]. 781 Nov 53

The authors undertook a retrospective study of 41 patients in whom an atrial septal aneurysm (ASA) had been diagnosed at transoesophageal echocardiography performed for ischaemic cerebrovascular events in 26 cases. No significant differences in this size, thickness or mobility of the ASA or the associated cardiac abnormalities were demonstrated in this context. However, patients presenting with cerebrovascular accidents were older, had several cardiovascular risk factors and more cardiac arrhythmias. These arrhythmias were usually related to other cardiac pathology such as ventricular hypertrophy or chronic cor pulmonale. Moreover, the probability of the cerebrovascular accident being related to the ASA was only acknowledged in 11 cases. These results mean a certain degree of discretion in diagnostic investigation and therapeutic management of these cases.
Arch Mal Coeur Vaiss 1994 Apr
PMID:[Aneurysm of the interatrial septum. Apropos of a retrospective study of 41 cases]. 784 33

In contrast with aortic valve replacement, the treatment of choice for severe aortic stenosis because of the better long-term results, percutaneous aortic valvuloplasty, has only limited indications, mainly because of the high rate of restenosis. However, in very elderly patients, the surgical risk is high, sometimes prohibitive. For this reason, the authors report their latest results with this technique in a series of octogenarians. Between January 1989 and December 1990, 70 aortic valvuloplasties were performed in octogenarians (average age 85 +/- 3 years). The indications were advanced age > or = 85 years (46%), poor left ventricular ejection fraction < 40% (20%), secere associated coronary artery disease (3%), associated extracardiac pathology (11%), poor general condition (11%) or refusal of surgery (4%). The great majority of these patients (83%) were very symptomatic: 70.5% had Grade III-IV dyspnoea, 20% had Grade III-IV angina and 20% had syncopal attacks. Valvuloplasty reduced the mean transvalvular pressure gradients from 61 +/- 23 to 30 +/- 11 mmHg (p < 0.01) and increased aortic valve surface area from 0.53 +/- 0.19 to 0.94 +/- 0.12 cm2 (p < 0.001). There were two deaths (2.9%) in the catheterization laboratory and 4 (5.7%) complications during the hospital period (myocardial infarction: 1, cerebrovascular accident: 1, severe aortic regurgitation: 1 and complete atrio-ventricular block: 1). There were no serious vascular complications. The average duration of the hospital period was 6 +/- 5 days. Clinical follow-up of 17 +/- 7 months was obtained in 97% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Arch Mal Coeur Vaiss 1993 Dec
PMID:[Current status of aortic valvuloplasty in patients aged 80 and over. Apropos of a recent series of 70 patients (1989-90)]. 802 67

Twenty-five normotensive men without any cardiac or arterial pathology, aged 22 to 68 years, 12 less than 45 year old, 13 over 45 years, underwent cardiac catheterisation and angiography. The following parameters were calculated: 1) a global index of arterial function (Ea) and its determining factors (Ea = LVESP/SV where LEVSP = left ventricular end systolic pressure and SV = left ventricular stroke volume); Ea = (HR x SVR) + Ea' where HR = heart rate, SVR = total systemic vascular resistance and Ea' = (LVESP - MAP/SV) (MAP = mean arterial pressure); 2) an index of global left ventricular pump function: ELV (ELV = LVESP/LVESV, where LVEDV = left ventricular end systolic volume; 3) an index of LV-arterial coupling: the Ea/ELV ratio. With aging, both Ea (by increase in SVR) and Ea' and ELV increased significantly. Ea/ELV (inverse of the ejection fraction-1) increased with age but ELV less than Ea. Ea/ELV was significantly higher in patients over 45 years of age but the correlation between ejection fraction and age was not statistically significant (p = 0.10). These results suggest that with aging, the improvement in LV pump function approximately corresponds to the degradation in arterial transport function: the left ventricular-arterial coupling as assessed by the Ea/ELV ratio (and therefore the ejection fraction) is maintained in the majority of cases.
Arch Mal Coeur Vaiss 1993 Aug
PMID:[Effects of aging on left ventricle-arterial coupling in man]. 812 7

Tortuous variants of the carotid or vertebral morphology are apparent on 10 to 43% of angiograms. It is probable that the incidence of these anomalies is lower in the normal population. Rarely, their etiology is congenital explaining the existence of some pediatric cases. The etiology of most cases is acquired and linked with hypertension, atheroma and aging. Basically consisting of an excess of length of the common or the internal carotid artery, the tortuosity may take the form of simple or multiple kinking, coiling or looping. Isolated, these anomalies are asymptomatic in a large majority of the cases. However, hemispheric, vertebrobasilar or ocular ischemic symptoms may be caused by them through a thromboembolic or hemodynamic mechanism. Moreover, given their frequent association with atherosclerotic occlusive lesions, their participation in the production of ischemic symptoms is not easy to determine. Although not yet investigated by prospective randomized studies, symptomatic isolated of kinking or coiling of cerebral arteries are amenable to surgical revascularization in order to prevent stroke or blindness. Besides, the endarterectomy of atherosclerotic occlusive lesions of tortuous carotids requires a technical adaptation.
J Mal Vasc 1994
PMID:[Loops and folds of the carotid and vertebral arteries: indications for surgery]. 815 90

We present our results of surgical correction of non-atheromatous redundant internal carotid arteries. From 1986 until 1992, we performed 1641 endarterectomies of the internal carotid artery, and in the same time we diagnosed 49 elongations in 42 patients. In 25 cases, indication for surgery was given and reconstruction was performed by shortening of the internal carotid artery, using resection and reanastomosis associated in one third of the cases with a patch. Nineteen patients (76%) were symptomatic, four patients (16%) presented a preoperative stroke and 2 patients (8%) were asymptomatic. All the patients were neurologically monitored by the use of somatosensory evoked potentials. One patient needed an intraluminal shunt because of loss of evoked potentials. No patient died in the postoperative period. One stroke occurred, concomitantly to a thrombosis of the internal carotid artery, but with totally reversible clinical symptoms after reoperation. We noted one transient ischaemic attack. We recommend operative treatment in symptomatic patients or when the stenosis is higher than 60%. A stenosis under 60% should be operated in the case of a contralateral occlusion. We propose a classification of redundant arteries based on the importance of the stenosis. The exact assessment of the stenosis is the determining factor in the diagnosis and is of primordial importance when indicating surgery.
J Mal Vasc 1994
PMID:[Loops and folds of the carotid and vertebral arteries: indications for surgery]. 815 91

The aim of this study was to evaluate the status of the native aortic valve in patients operated for acute dissection of the ascending. aorta (ADAA). Between November 1972 and November 1991, 93 patients were operated for ADAA. There were 76 men and 17 women (average age 54 +/- 12 years). The aortic valve was reserved in 80 cases (86%). In 13 patients (14%) aortic valve replacement was associated with replacement of the ascending aorta. The early mortality was 29% (27/93). The global actuarial survival rates at 5, 10 and 15 years were 60.2 +/- 5.2%, 49.7 +/- 6.1% and 26.9 +/- 9.9% respectively. Fifty patients (94%) in whom the native aortic valve was preserved were followed up. Nine patients (18%) died and average of 97 +/- 46 months after surgery. The causes of death were aortic rupture or extension of the dissection (N = 4), ischemic cardiac failure (N = 2), renal failure (N = 1), cerebrovascular accident (N = 1) and sudden death (N = 1). Forty one patients underwent transthoracic echocardiography. Seven patients developed severe aortic regurgitation, 6 of whom had to be reoperated for aortic valve replacement. Echocardiography showed absence of of minimal aortic regurgitation in 22 cases and mild aortic regurgitation with normal left ventricular function in 12 cases (in 2 cases, aortic valve replacement was associated with surgical treatment of another valvular lesion or of coronary artery disease). Therefore, aortic valve replacement was performed in 8 patients 61.5 +/- 51.2 months after the initial operation.(ABSTRACT TRUNCATED AT 250 WORDS)
Arch Mal Coeur Vaiss 1993 Mar
PMID:[Preservation of the aortic valve in acute dissection of the ascending aorta]. 821 67

The authors report the case of a 40 year old woman who had an ischemic stroke. The initial investigation including a complete blood clotting analysis, failed to demonstrate the cause. Five years later, the investigations were completed systematically by transesophageal echocardiography which demonstrated an isolated thrombus localised in the left atrial appendage though the localisation heart was in sinus rhythm and morphologically normal. This case illustrates in the diagnostic yield of transesophageal echocardiography in the investigation of systemic embolism in young patients who have had a cerebral ischemic event of unknown cause, even in the absence of predisposing cardiac cause.
Arch Mal Coeur Vaiss 1993 Apr
PMID:[Incidental finding of an isolated thrombus in the left atrium in a young woman with sinus rhythm 5 years after cerebral ischemic accident]. 823 79

Every year in France, approximately 12,000 strokes are due to stenosis of an extracranial internal carotid artery. One third of these patients are dead and one third have disabling sequelae at 6 months follow up, emphasizing the need for prophylactic therapy. The efficacy of antiaggregants and the value of correction of risk factors have been proven for a decade or more, whereas carotid artery surgery has for a long time been a subject for debate because of its perioperative complications and the lack of consensus on its indications. Happily, several recent multicenter studies have provided positive evidence of its value. After a transient ischemic accident or mild stroke, patients with a stenosis of more than 70% should be operated upon, in the absence of any local or general contraindication and if the surgical team has a record of a less than 5% cumulated mortality and neurologic morbidity. For asymptomatic severe stenotic lesions, it appears justified to operate on those occluding by more than 80%, in patients presenting the same characteristics and if the surgical team's incidence of complications is less than 3%. Although arguments exist for operating upon a severe carotid artery stenosis associated with vertebrobasilar insufficiency or severe stroke without major cerebral impairment, these indications have not been evaluated by multicenter trials and each case should be treated individually.
J Mal Vasc 1993
PMID:[Carotid surgery. Assessment and current problems]. 825 38

The European Carotid Surgery Trial (ECST) is an ongoing randomised trial of immediate carotid endarterectomy vs non-surgery in symptomatic patients with recent and mild carotid territory ischaemic events. So far it is become clear that the risk of the operation is--in general--worth taking in patients with "severe" stenosis (> 70% of the proximal internal carotid artery diameter) but not in patients with "mild" stenosis (0-29%). The balance of risk vs benefit in patients with "moderate" stenosis (30-69%) is still unclear und recruitment of such patients continues. All patients are still being followed up to assess the durability of any benefit of surgery and to develop prognostic models to predict the risk of ipsilateral ischemic stroke in the no-surgery patients. Also, further studies are being done to investigate the best method of measuring the amount of disease at the carotid bifurcation.
J Mal Vasc 1993
PMID:Symptomatic patients: the European Carotid Surgery Trial (ECST). 825 41


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