Search

The aim ot tnis study was to assess the results of interventional strategy in patients over 75 years of age admitted to hospital with acute coronary syndromes (ACS) without persistent ST elevation. Over three months, patients over the age of 75 undergoing coronary angiography for ACS were included in a multicentre register and followed up for 6 months. A total of 126 patients with an average age of 79 were included: 70% had at least one poor prognostic factor. The treatment on admission included: Aspirin (84%), Clopidogrel (60%), anti GpIIb-IIIa (12%) and Heparin (81%, of which 3/4 of cases were low molecular weight heparins). Coronary angiography (average delay 80 hours) showed single, double and triple vessel disease in 21, 29 and 35% of cases respectively. Coronary angioplasty was proposed in 83 patients and carried out in 82. Eleven patients underwent coronary artery bypass grafting and 31 were treated medically. During the hospital phase, there were 3 major cardiovascular complications: 1 death during coronary angiography, 1 intra-stent thrombosis and 1 death in the group undergoing bypass grafting, with no major bleeding complications. At 6 months, there were 8 (6.5%) major cardiovascular adverse events with 6 in the "angioplasty" group; 5 deaths (3 cardiac deaths), 3 myocardial infarcts. Two thirds of patients were asymptomatic. The authors conclude that interventional strategy in ACS of elderly patients is associated with a low rate of major adverse events. The benefits of this strategy should be confirmed by randomised trial.

The authors report the results of a series of 3 cases of double valvuloplasty with a balloon catheter in young patients with combined mitral and tricuspid stenosis. Haemodynamic and Doppler echocardiographic evaluation after the procedure showed comparable results to those of surgical commissurotomy without significant secondary valvular regurgitation. Clinical and echocardiographic follow-up showed that valvular opening remained satisfactory in the 2 cases examined. Percutaneous valvuloplasty would seem to be a valuable alternative to surgical commissurotomy in selected patients with combined mitral and tricuspid valve stenosis.

Seventy-two consecutive patients with severe aortic stenosis and impaired by left ventricular ejection fractions (EF less than 40%) underwent percutaneous aortic valvuloplasty between September 1985 and November 1987. Forty-five patients had been turned down by the surgeons because of their age (29 patients over 80 years of age), their impaired left ventricular function or associated pathologies. Valvular dilatation with 15 to 23 mm diameter balloons resulted in a reduction of the transvalvular pressure gradient from 63 +/- 21 to 26 +/- 11 mmHg (p less than 0.001) and an increase in valve surface area from 0.48 +/- 0.15 to 0.91 +/- 0.32 cm2 (p less than 0.001) but with large individual variations. No cases of aggravation of associated aortic insufficiency were observed after the procedure. One 98-year old woman died during the dilatation and 4 other patients died during the hospital period. Immediate clinical improvement was observed in 80 per cent of patients. During the one-year follow-up period, 33 patients died, 31 of cardiac causes. Of the 34 survivors at one year, 21 had maintained their clinical improvement. A repeat hemodynamic study was performed in 22 patients 7 months after valvuloplasty. Eleven patients had restenosed and their hemodynamic parameters had practically returned to pre-valvuloplasty values. The left ventricular ejection fractions of the 11 patients without restenosis had increased from 28 +/- 7 to 40 +/- 18 per cent (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Although the Starr valve still is the most commonly used prosthesis, no systematic Doppler evaluation of its normal functioning has yet been performed. For this reason, 49 patients with mitral (25) or aortic (25) Starr valve and without evidence of cardiac failure, other valve disease or coronary disease were prospectively explored. Parameters measured were: maximum velocity, maximum and mean gradients, half-decrease time under pressure and corresponding valve areas. A. Mitral prosthesis. With Starr valves size 3 M and 4 M, corresponding to diameters of 30 and 32 mm respectively, the results obtained were: Vmax 1,7 +/- 0.3 m/s, maximum gradient 12.3 +/- 4.5 mmHg, mean gradient 5.3 +/- 2.2 mmHg, T1/2 120 + 30 ms, valve area 1.96 + 0.45 cm2. These 5 parameters were not significantly different with 3M and 4M valves. B. Aortic prosthesis. Contrary to mitral valve prosthesis, the results here were influenced by the size of the valve. With Starr valve No 10 (diameter 24 mm), values were: Vmax 3.3 +/- 0.4 m/s, maximum gradient 45 +/- 11.6 mmHg, mean gradient 26.7 +/- 8.8 mmHg. Aortic regurgitation was present in 20 p. 100 of the cases. The validity of the continuity equation was tested for non-invasive determination of the aortic valve functional area.