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Research paper thumbnail of Off-pump Myocardial Revascularization for Left Main Stem Disease in a High-risk Patient

Acta Chirurgica Belgica, Dec 1, 1999

Off-pump complete myocardial revascularization for three-vessel disease is often limited by the d... more Off-pump complete myocardial revascularization for three-vessel disease is often limited by the difficulty to approach the obtuse marginal branches. A method of coronary artery bypass grafting without cardiopulmonary bypass used in a high risk patient with left main stem and three-vessel disease is described.

Research paper thumbnail of Complications hémorragiques et syndromes coronariens aigus

Research paper thumbnail of La récidive angiographique après angioplastie coronaire sans récidive des symptomes

Research paper thumbnail of Prognostic impact of moderate coronary artery disease diagnosed by coronary angiography. A substudy of the MONICA survey

Research paper thumbnail of Gender specific changes of 28-days outcome after hospital admission for myocardial infarction during the period 1985-2004 observed by a Belgian epidemiological registry (MONICA-BELLUX)

Research paper thumbnail of Atrial natriuretic factor during percutaneous transluminal coronary angioplasty

Acta cardiologica, 1991

To study the release of plasma atrial natriuretic factor (ANF) and to explain the mechanism under... more To study the release of plasma atrial natriuretic factor (ANF) and to explain the mechanism underlying its increase during myocardial ischemia, we measured plasma ANF and mean pulmonary capillary wedge pressure (PCW) before, during and after percutaneous transluminal coronary angioplasty (PTCA) in eight patients. All patients were free of calcium channel antagonists and beta-blocking drugs. Evidence of myocardial ischemia was observed in all patients with an increase of PCW from 3.2 +/- 1.2 to 10.6 +/- 2.9 mm Hg (mean +/- SD; p less than 0.001). Heart rate and mean blood pressure did not change significantly. We observed an increase of plasma ANF during PTCA, from 53 +/- 24 to 100 +/- 37 pmol/L (mean +/- SD; p less than 0.005). There was a correlation between absolute values of ANF and PCW before and during PTCA (r = 0.64, p less than 0.01). After PTCA, ANF levels remained increased for at least twenty minutes (p less than 0.005 vs basal state) despite a decrease in PCW. Thus, incre...

Research paper thumbnail of Evaluation in vivo of the endothelial function of the native gastroepiploic artery

American Heart Journal, 1998

There is controversy as to the optimal management of patients with diabetes and multivesset coron... more There is controversy as to the optimal management of patients with diabetes and multivesset coronary artery disease requiring revascularization. This study was undertaken to compare the outcomes of patients with diabetes who underwent either percutaneous translumina[ coronary angioplasty (PTCA; n = 834) or coronary artery bypass graft surgery (CABG; n = 1,805). Data were collected prospectively b 7 using a computerized database from 1981 through 1994. The ia-hospital mortality rate was greater in the CABG group (4.99% v 0.36%; p < 0.0001) and there was a trend toward more Q wave infarctions in this group. There was no difference in the 5-year and 10-yeer survival rates for either procedure (76% v 78% and 48% v 45%, respectively). Using multivariate analysis, there was a higher mortality rate in the insulin-dependent subgroup for PTCA than for CABG (hazards ratio, 1.35; 95% confidence interval, 1.01 to 1.79; p = 0.045). Additional revascularization was more common after PTCA. Confirming that morbidity and mortality are prevalent in diabetic patients, this study raises further questions about PTCA in insulin-dependent diabetic patients with multivessel coronary artery disease.

Research paper thumbnail of Indium-111 platelet scintigraphy and two dimensional echo-cardiography in the diagnosis of left ventricular thrombi

The American Journal of Cardiology, 1981

Research paper thumbnail of Acute and One-year Follow-up of Free Epigastric Arterial Bypass Grafts - a Qualitative and Quantitative Angiographic Assessment

Research paper thumbnail of Relationship between hospital volume and in-hospital mortality in contemporary percutaneous coronay intervention

Research paper thumbnail of Transesophageal echocardiography in infective endocarditis

American journal of cardiac imaging, 1988

Research paper thumbnail of Changes in the use of invasive diagnostic/therapeutic procedures over a 20-year period assessed by a prospective population-based registry (WHO MONICA-BELLUX)

Research paper thumbnail of Quantitative angiographic follow-up study of the free inferior epigastric coronary bypass graft

Circulation, 1994

Attempts to improve late results of bypass coronary surgery have focused on the use of arterial c... more Attempts to improve late results of bypass coronary surgery have focused on the use of arterial conduits because of the high attrition rate of venous grafts. In our institution, 150 patients received an inferior epigastric artery (EPIG) as a free bypass graft, anastomosed to the right coronary artery in 73% and to a marginal branch in 20% of cases. These patients were followed prospectively by qualitative and quantitative angiography. Angiographic studies were performed in 122 patients (81%) early after surgery (11 +/- 5 days), and in 72 cases, a late evaluation (11 +/- 6 months) was also obtained. Quantative angiography (basal and after isosorbide dinitrate [ISDN]) was performed on the in situ EPIG in a large subset of these patients, as well as in 59 patients before bypass surgery. The patency rate was 98% at early control and remained high (93%) at late control. However, at late control, 14 EPIGs were occluded or threadlike, but of these 14, eight were grafted on a coronary arter...

Research paper thumbnail of Non-invasive imaging and functional evaluation of the right gastroepiploic artery as an in situ coronary artery bypass graft

Research paper thumbnail of The immediate and long-term effect of optimal balloon angioplasty on the absolute coronary blood flow velocity reserve. A subanalysis of the DEBATE study

European Heart Journal, 2001

Research paper thumbnail of Angiographical and Doppler flow-derived parameters for assessment of coronary lesion severity and its relation to the result of exercise electrocardiography

European Heart Journal, 2000

Aims Evaluation of angiographical and intracoronary Doppler-derived parameters of coronary stenos... more Aims Evaluation of angiographical and intracoronary Doppler-derived parameters of coronary stenosis severity. Methods and Results A total of 225 patients with onevessel disease were studied before PTCA and at 6 months follow-up. Exercise electrocardiography was performed to document presence (n=157) or absence (n=138) of an ST segment shift (d0•1 mV). Intracoronary blood flow velocity analysis was performed to determine the proximal/ distal flow velocity ratio, the distal diastolic/systolic flow velocity ratio and coronary flow velocity reserve. Receiver operator characteristic curves were calculated to assess the predictive value of these variables compared with the exercise test. The distal coronary flow velocity reserve demonstrated the best linear correlation for both percentage diameter stenosis and minimum lumen diameter (r=0•67 and r=0•66; P<0•01), compared to the diastolic/ systolic flow velocity ratio (r=0•19 and r=0•14; P<0•01) and the proximal/distal flow velocity ratio (r=0•03 and r=0•07; not significant). The areas under the curve were 0•84 0•02; 0•82 0•03 and 0•83 0•03 for diameter sten-osis, minimum lumen diameter and coronary flow velocity reserve, respectively. Logistic regression analysis revealed that the percentage diameter stenosis or minimum lumen diameter and coronary flow velocity reserve were independent predictors for the result of stress testing. Conclusions The distal coronary flow velocity reserve is the best intracoronary Doppler parameter for evaluation of coronary narrowings. Angiographical estimates of coronary lesion severity and distal coronary flow velocity reserve are good and independent predictors for the assessment of functional severity of coronary stenosis, emphasizing the complementary role of these parameters for clinical decision making.

Research paper thumbnail of Prognostic Value of Intracoronary Flow Velocity and Diameter Stenosis in Assessing the Short- and Long-term Outcomes of Coronary Balloon Angioplasty

Circulation, 1997

Background The aim of this prospective, multicenter study was the identification of Doppler flow ... more Background The aim of this prospective, multicenter study was the identification of Doppler flow velocity measurements predictive of clinical outcome of patients undergoing single-vessel balloon angioplasty with no previous Q-wave myocardial infarction. Methods and Results In 297 patients, a Doppler guidewire was used to measure basal and maximal hyperemic flow velocities proximal and distal to the stenosis before and after angioplasty. In 225 patients with an angiographically successful percutaneous transluminal coronary angioplasty (PTCA), postprocedural distal coronary flow reserve (CFR) and percent diameter stenosis (DS%) were correlated with symptoms and/or ischemia at 1 and 6 months, with the need for target lesion revascularization, and with angiographic restenosis (defined as DS ≥50% at follow-up). Logistic regression and receiver operator characteristic curve analyses were applied to determine the prognostic cutoff value of CFR and DS separately and in combination. Optimal ...

Research paper thumbnail of Evaluation of ketanserin in the prevention of restenosis after percutaneous transluminal coronary angioplasty. A multicenter randomized double-blind placebo-controlled trial

Circulation, 1993

BACKGROUND Ketanserin is a serotonin S2-receptor antagonist that inhibits the platelet activation... more BACKGROUND Ketanserin is a serotonin S2-receptor antagonist that inhibits the platelet activation and vasoconstriction induced by serotonin and also inhibits the mitogenic effect of serotonin on vascular smooth muscle cells. METHODS AND RESULTS We conducted a randomized, double blind, placebo-controlled trial to assess the effect of ketanserin in restenosis prevention after percutaneous transluminal coronary angioplasty (PTCA). Patients received either ketanserin (loading dose, 40 mg 1 hour before PTCA; maintenance dose, 40 mg bid for 6 months) or matched placebo. In addition, all patients received aspirin for 6 months. Coronary angiograms before PTCA, after PTCA, and at 6 months were quantitatively analyzed. Six hundred fifty-eight patients were entered into the intention-to-treat analysis. The primary clinical end point of the study was the occurrence between PTCA and 6 months of any one of the following: cardiac death, myocardial infarction, the need for repeat angioplasty, or by...

Research paper thumbnail of Suivi à court et à long terme après chirurgie de remplacement valvulaire aortique par une prothèse mécanique

Research paper thumbnail of Echocardiographic Parameters Associated With Asymmetrical Structural Remodeling In Patients With Or Without Atrial Fibrillation

PubMed, Dec 1, 2014

Objectives: Left atrial (LA) dilation can evolve into asymmetrical remodeling. The aim of this st... more Objectives: Left atrial (LA) dilation can evolve into asymmetrical remodeling. The aim of this study was to determine the echocardiographic parameters associated with LA asymmetric structural remodeling (ASR) in patients with and without nonvalvular atrial fibrillation (AF). Methods and results: A total of 170 patients with a dilated LA were prospectively enrolled. ASR was defined as an atrium shape that is no longer ellipsoidal (LA basal dimension measured at the junction between the pulmonary vein and atrium greater than the mitral annular dimension). Symmetric structural remodeling (SSR) was defined as all other cases. Echocardiographic parameters of LA function and left ventricular diastolic function, measured by pulsed-wave Doppler and Tissue Doppler Imaging, were analyzed to identify the parameters associated with ASR. The mean age of the patients was 67 ± 11 years. Forty-one percent had a stable sinus rhythm (SR), and 59% had AF. LA-ASR was detected in 66% of the patients: 55% with AF and 45% with SR (p=0.002). The mean LA-ASR and LA-SSR volume indexes were 49 ± 14 ml/m² and 29 ± 13 ml/m², respectively (p<0.001). LA systolic myocardial velocity (p=0.036) and peak systolic pulmonary venous flow velocity (p=0.033) were the parameters best associated with ASR. The sensitivity and specificity of both parameters, based on ROC curve analysis, were 77 and 70%, respectively. The AUC was 0.765 (95% CI: 0.662-0.849, p=0.0001). Conclusion: LA dilation is associated with a great number of asymmetrical structural remodeling. Echocardiographic parameters that reflect LA reservoir function are best associated with asymmetrical remodeling.

Research paper thumbnail of Off-pump Myocardial Revascularization for Left Main Stem Disease in a High-risk Patient

Acta Chirurgica Belgica, Dec 1, 1999

Off-pump complete myocardial revascularization for three-vessel disease is often limited by the d... more Off-pump complete myocardial revascularization for three-vessel disease is often limited by the difficulty to approach the obtuse marginal branches. A method of coronary artery bypass grafting without cardiopulmonary bypass used in a high risk patient with left main stem and three-vessel disease is described.

Research paper thumbnail of Complications hémorragiques et syndromes coronariens aigus

Research paper thumbnail of La récidive angiographique après angioplastie coronaire sans récidive des symptomes

Research paper thumbnail of Prognostic impact of moderate coronary artery disease diagnosed by coronary angiography. A substudy of the MONICA survey

Research paper thumbnail of Gender specific changes of 28-days outcome after hospital admission for myocardial infarction during the period 1985-2004 observed by a Belgian epidemiological registry (MONICA-BELLUX)

Research paper thumbnail of Atrial natriuretic factor during percutaneous transluminal coronary angioplasty

Acta cardiologica, 1991

To study the release of plasma atrial natriuretic factor (ANF) and to explain the mechanism under... more To study the release of plasma atrial natriuretic factor (ANF) and to explain the mechanism underlying its increase during myocardial ischemia, we measured plasma ANF and mean pulmonary capillary wedge pressure (PCW) before, during and after percutaneous transluminal coronary angioplasty (PTCA) in eight patients. All patients were free of calcium channel antagonists and beta-blocking drugs. Evidence of myocardial ischemia was observed in all patients with an increase of PCW from 3.2 +/- 1.2 to 10.6 +/- 2.9 mm Hg (mean +/- SD; p less than 0.001). Heart rate and mean blood pressure did not change significantly. We observed an increase of plasma ANF during PTCA, from 53 +/- 24 to 100 +/- 37 pmol/L (mean +/- SD; p less than 0.005). There was a correlation between absolute values of ANF and PCW before and during PTCA (r = 0.64, p less than 0.01). After PTCA, ANF levels remained increased for at least twenty minutes (p less than 0.005 vs basal state) despite a decrease in PCW. Thus, incre...

Research paper thumbnail of Evaluation in vivo of the endothelial function of the native gastroepiploic artery

American Heart Journal, 1998

There is controversy as to the optimal management of patients with diabetes and multivesset coron... more There is controversy as to the optimal management of patients with diabetes and multivesset coronary artery disease requiring revascularization. This study was undertaken to compare the outcomes of patients with diabetes who underwent either percutaneous translumina[ coronary angioplasty (PTCA; n = 834) or coronary artery bypass graft surgery (CABG; n = 1,805). Data were collected prospectively b 7 using a computerized database from 1981 through 1994. The ia-hospital mortality rate was greater in the CABG group (4.99% v 0.36%; p < 0.0001) and there was a trend toward more Q wave infarctions in this group. There was no difference in the 5-year and 10-yeer survival rates for either procedure (76% v 78% and 48% v 45%, respectively). Using multivariate analysis, there was a higher mortality rate in the insulin-dependent subgroup for PTCA than for CABG (hazards ratio, 1.35; 95% confidence interval, 1.01 to 1.79; p = 0.045). Additional revascularization was more common after PTCA. Confirming that morbidity and mortality are prevalent in diabetic patients, this study raises further questions about PTCA in insulin-dependent diabetic patients with multivessel coronary artery disease.

Research paper thumbnail of Indium-111 platelet scintigraphy and two dimensional echo-cardiography in the diagnosis of left ventricular thrombi

The American Journal of Cardiology, 1981

Research paper thumbnail of Acute and One-year Follow-up of Free Epigastric Arterial Bypass Grafts - a Qualitative and Quantitative Angiographic Assessment

Research paper thumbnail of Relationship between hospital volume and in-hospital mortality in contemporary percutaneous coronay intervention

Research paper thumbnail of Transesophageal echocardiography in infective endocarditis

American journal of cardiac imaging, 1988

Research paper thumbnail of Changes in the use of invasive diagnostic/therapeutic procedures over a 20-year period assessed by a prospective population-based registry (WHO MONICA-BELLUX)

Research paper thumbnail of Quantitative angiographic follow-up study of the free inferior epigastric coronary bypass graft

Circulation, 1994

Attempts to improve late results of bypass coronary surgery have focused on the use of arterial c... more Attempts to improve late results of bypass coronary surgery have focused on the use of arterial conduits because of the high attrition rate of venous grafts. In our institution, 150 patients received an inferior epigastric artery (EPIG) as a free bypass graft, anastomosed to the right coronary artery in 73% and to a marginal branch in 20% of cases. These patients were followed prospectively by qualitative and quantitative angiography. Angiographic studies were performed in 122 patients (81%) early after surgery (11 +/- 5 days), and in 72 cases, a late evaluation (11 +/- 6 months) was also obtained. Quantative angiography (basal and after isosorbide dinitrate [ISDN]) was performed on the in situ EPIG in a large subset of these patients, as well as in 59 patients before bypass surgery. The patency rate was 98% at early control and remained high (93%) at late control. However, at late control, 14 EPIGs were occluded or threadlike, but of these 14, eight were grafted on a coronary arter...

Research paper thumbnail of Non-invasive imaging and functional evaluation of the right gastroepiploic artery as an in situ coronary artery bypass graft

Research paper thumbnail of The immediate and long-term effect of optimal balloon angioplasty on the absolute coronary blood flow velocity reserve. A subanalysis of the DEBATE study

European Heart Journal, 2001

Research paper thumbnail of Angiographical and Doppler flow-derived parameters for assessment of coronary lesion severity and its relation to the result of exercise electrocardiography

European Heart Journal, 2000

Aims Evaluation of angiographical and intracoronary Doppler-derived parameters of coronary stenos... more Aims Evaluation of angiographical and intracoronary Doppler-derived parameters of coronary stenosis severity. Methods and Results A total of 225 patients with onevessel disease were studied before PTCA and at 6 months follow-up. Exercise electrocardiography was performed to document presence (n=157) or absence (n=138) of an ST segment shift (d0•1 mV). Intracoronary blood flow velocity analysis was performed to determine the proximal/ distal flow velocity ratio, the distal diastolic/systolic flow velocity ratio and coronary flow velocity reserve. Receiver operator characteristic curves were calculated to assess the predictive value of these variables compared with the exercise test. The distal coronary flow velocity reserve demonstrated the best linear correlation for both percentage diameter stenosis and minimum lumen diameter (r=0•67 and r=0•66; P<0•01), compared to the diastolic/ systolic flow velocity ratio (r=0•19 and r=0•14; P<0•01) and the proximal/distal flow velocity ratio (r=0•03 and r=0•07; not significant). The areas under the curve were 0•84 0•02; 0•82 0•03 and 0•83 0•03 for diameter sten-osis, minimum lumen diameter and coronary flow velocity reserve, respectively. Logistic regression analysis revealed that the percentage diameter stenosis or minimum lumen diameter and coronary flow velocity reserve were independent predictors for the result of stress testing. Conclusions The distal coronary flow velocity reserve is the best intracoronary Doppler parameter for evaluation of coronary narrowings. Angiographical estimates of coronary lesion severity and distal coronary flow velocity reserve are good and independent predictors for the assessment of functional severity of coronary stenosis, emphasizing the complementary role of these parameters for clinical decision making.

Research paper thumbnail of Prognostic Value of Intracoronary Flow Velocity and Diameter Stenosis in Assessing the Short- and Long-term Outcomes of Coronary Balloon Angioplasty

Circulation, 1997

Background The aim of this prospective, multicenter study was the identification of Doppler flow ... more Background The aim of this prospective, multicenter study was the identification of Doppler flow velocity measurements predictive of clinical outcome of patients undergoing single-vessel balloon angioplasty with no previous Q-wave myocardial infarction. Methods and Results In 297 patients, a Doppler guidewire was used to measure basal and maximal hyperemic flow velocities proximal and distal to the stenosis before and after angioplasty. In 225 patients with an angiographically successful percutaneous transluminal coronary angioplasty (PTCA), postprocedural distal coronary flow reserve (CFR) and percent diameter stenosis (DS%) were correlated with symptoms and/or ischemia at 1 and 6 months, with the need for target lesion revascularization, and with angiographic restenosis (defined as DS ≥50% at follow-up). Logistic regression and receiver operator characteristic curve analyses were applied to determine the prognostic cutoff value of CFR and DS separately and in combination. Optimal ...

Research paper thumbnail of Evaluation of ketanserin in the prevention of restenosis after percutaneous transluminal coronary angioplasty. A multicenter randomized double-blind placebo-controlled trial

Circulation, 1993

BACKGROUND Ketanserin is a serotonin S2-receptor antagonist that inhibits the platelet activation... more BACKGROUND Ketanserin is a serotonin S2-receptor antagonist that inhibits the platelet activation and vasoconstriction induced by serotonin and also inhibits the mitogenic effect of serotonin on vascular smooth muscle cells. METHODS AND RESULTS We conducted a randomized, double blind, placebo-controlled trial to assess the effect of ketanserin in restenosis prevention after percutaneous transluminal coronary angioplasty (PTCA). Patients received either ketanserin (loading dose, 40 mg 1 hour before PTCA; maintenance dose, 40 mg bid for 6 months) or matched placebo. In addition, all patients received aspirin for 6 months. Coronary angiograms before PTCA, after PTCA, and at 6 months were quantitatively analyzed. Six hundred fifty-eight patients were entered into the intention-to-treat analysis. The primary clinical end point of the study was the occurrence between PTCA and 6 months of any one of the following: cardiac death, myocardial infarction, the need for repeat angioplasty, or by...

Research paper thumbnail of Suivi à court et à long terme après chirurgie de remplacement valvulaire aortique par une prothèse mécanique

Research paper thumbnail of Echocardiographic Parameters Associated With Asymmetrical Structural Remodeling In Patients With Or Without Atrial Fibrillation

PubMed, Dec 1, 2014

Objectives: Left atrial (LA) dilation can evolve into asymmetrical remodeling. The aim of this st... more Objectives: Left atrial (LA) dilation can evolve into asymmetrical remodeling. The aim of this study was to determine the echocardiographic parameters associated with LA asymmetric structural remodeling (ASR) in patients with and without nonvalvular atrial fibrillation (AF). Methods and results: A total of 170 patients with a dilated LA were prospectively enrolled. ASR was defined as an atrium shape that is no longer ellipsoidal (LA basal dimension measured at the junction between the pulmonary vein and atrium greater than the mitral annular dimension). Symmetric structural remodeling (SSR) was defined as all other cases. Echocardiographic parameters of LA function and left ventricular diastolic function, measured by pulsed-wave Doppler and Tissue Doppler Imaging, were analyzed to identify the parameters associated with ASR. The mean age of the patients was 67 ± 11 years. Forty-one percent had a stable sinus rhythm (SR), and 59% had AF. LA-ASR was detected in 66% of the patients: 55% with AF and 45% with SR (p=0.002). The mean LA-ASR and LA-SSR volume indexes were 49 ± 14 ml/m² and 29 ± 13 ml/m², respectively (p<0.001). LA systolic myocardial velocity (p=0.036) and peak systolic pulmonary venous flow velocity (p=0.033) were the parameters best associated with ASR. The sensitivity and specificity of both parameters, based on ROC curve analysis, were 77 and 70%, respectively. The AUC was 0.765 (95% CI: 0.662-0.849, p=0.0001). Conclusion: LA dilation is associated with a great number of asymmetrical structural remodeling. Echocardiographic parameters that reflect LA reservoir function are best associated with asymmetrical remodeling.