Search PubMed⌕ Search

Biomedical subjects

H Suma

Publications and source records attributed to H Suma.

At least 55 records · Page 3Linked to original sources
PubMed1996

Effects of competitive blood flow on arterial graft patency and diameter. Medium-term postoperative follow-up.

To identify predictors of arterial graft patency, we followed up 30 internal thoracic arterial grafts and 23 right gastroepiploic arterial grafts in situ with patency documented during postoperative angiography. After 24 months of follow-up on average, repeat angiography detected that one internal thoracic artery and two gastroepiploic arteries were anatomically occluded and that the other three gastroepiploic arteries were nonfunctioning. The logistic regression model identified a relationship between graft patency and competitive flow, which was detected as stenosis in the recipient coronary arteries (coefficients, p < 0.05; model, Hosmer-Lemeshow chi2 statistic 3.59, p = 0.89). The linear regression model demonstrated that changes in graft luminal diameter correlated with competitive flow (p < 0.01), smoking history (p < 0.05), and type of arterial grafts (p < 0.001) (R2 = 0.40, adjusted R2 = 0.36). The findings suggest a temporal relationship between competitive flow and prognosis of arterial graft.

Abdominal Muscles↗
PubMed1996

Gastroepiploic artery graft in 400 patients.

The right gastroepoploic artery (GEA) has been used for coronary artery bypass grafting (CABG) in 400 patients of a total of 1359 undergoing the same procedure during an 8-year period. There were 327 males and 73 females with a mean age of 59 years. Single-, double- and triple-vessel and left main disease were noted in 4, 51, 283 and 62 patients, respectively. Previous myocardial infarction was noted in 208 patients and 40 patients had undergone previous CABG. Internal thoracic artery (ITA) and inferior epigastric artery grafts were concomitantly used in 388 (97%) and 30 (8%) patients, respectively. The mean number of grafts was 3.2 including vein grafts, and 2.3 coronary arteries were bypassed with arterial grafts. The sites of GEA grafting were 43 anterior descending, 6 diagonal, 71 circumflex, and 287 right coronary arteries with 376 in situ and 24 free grafts including 7 sequential grafts. There were eight (2%) early and five (1.3%) late deaths. New Q waves were noted in six (1.5%) patients. Warm body circulation is thought to be favorable with a lower incidence of the need for intra-aortic balloon pump (0.6% vs 6.0%). Postoperative angiography revealed 94% (253/268) early (2 months) and 94% (47/50) late (2-5 years) patency of GEA grafts. In conclusion. GEA is a safe and effective arterial conduit for CABG.

Abdominal Muscles↗
PubMed1996

Prolonged luminal narrowing of internal mammary artery graft after percutaneous transluminal angioplasty.

The authors describe a case with an internal mammary artery (IMA) graft that demonstrated prolonged, but reversible, luminal narrowing persisting > twenty-four hours following percutaneous transluminal angioplasty. Luminal narrowing disappeared spontaneously, however, at the time of follow-up angiography one week after the angioplasty. Since haziness at the dilation site had been shown on preprocedural angiogram, suggestive of intraluminal thrombus, this phenomenon may be attributed to either prolonged vasospasm or distal embolization of the IMA graft.

Angioplasty, Balloon, Coronary↗
PubMed1996

Long-term outcome of percutaneous transluminal coronary angioplasty and coronary bypass surgery for multivessel coronary artery disease.

We studied the short- and long-term outcomes of 97 patients treated with percutaneous transluminal coronary angioplasty (PTCA) and 72 patients treated with coronary artery bypass graft surgery (CABG) for multivessel coronary artery disease in a single hospital in 1989. Patients treated with CABG had a higher angina class, a higher incidence of diabetes mellitus and a greater extent of the disease. Complete revascularization was achieved in 61 patients (85%) with CABG and in 45 patients (46%) with PTCA (p < 0.001). Initial success of PTCA and CABG was obtained in 95% and 94% of the patients with PTCA and CABG, respectively. Actuarial survival rates at 5 years were similar (96% in the PTCA group; 94% in the CABG group). Fewer patients suffered from cardiac death or myocardial infarction in the CABG group than in the PTCA group, but this difference was not significant. The rate of survival free from death, myocardial infarction, CABG and repeat PTCA, was significantly higher in the CABG group than in the PTCA group (85% vs 48%; p < 0.001). These results suggest that CABG provides a favorable long-term outcome in patients with multivessel coronary artery disease and that PTCA provides a similar outcome in these patients when applied to suitable lesions, although more patients who undergo PTCA require repeat procedures.

Aged↗
PubMed1996

[Multivessel coronary artery bypass grafting with arterial conduits].

With increased use of catheter intervention, candidates for coronary artery bypass grafting (CABG) have become more severely diseased. In the past 4 years with normothermic cardiopulmonary bypass technique, operative mortality was 1.5% (0.7% for elective and 5.6% for emergency) in 690 primary CABGs. The internal thoracic artery graft was used in 94% of the patients and the patency rate was 98%. The gastroepiploic artery was used in 565 patients since 1986 with 2.3% operative mortality and the patency rate was 96% in early and 92% in mid-term angiography. The inferior epigastric artery was used in 48 patients with 2% operative mortality and 90% patency rate. The radial artery was used in 105 patients with 0.9% operative mortality and patency rate was 88% at 1 postoperative year. Surgical result and angiographic patency of the graft are acceptably good while candidates of CABG have become more severely diseased. With use of arterial conduits, better long term outcome can be expected.

Adult↗
PubMed1996

Optimal use of the gastroepiploic artery.

In 10 years' experience with the right gastroepiploic artery graft for myocardial revascularization, excellent clinical and angiographic mid-term results have been reported. From our experience in 518 patients who underwent CABG with a gastroepiploic artery graft since 1986, early and late mortality rates were 2.3% and 1.0%, respectively. Early and mid-term (2 to 5 years) angiographic patency rates were 96% and 92%, respectively, in the in situ gastroepiploic artery grafts. The gastroepiploic artery is the second best arterial conduit next to the internal thoracic artery at present, and is most useful at reoperation or for patients with atherosclerotic ascending aorta. With proper basic knowledge and surgical technique, the gastroepiploic artery can be used without increasing surgical mortality and morbidity, and good long-term patency can be expected.

Adolescent↗
PubMed1996

[A case of familial cardiac myxoma].

We experienced a case of familial cardiac myxoma observed in a mother and her daughter. A 58-year-old woman was addmited to our hospital because of repeated cerebral embolism. Echocardiography showed a left atrial myxoma to be considered as the cause of cerebral embolism. At the operation, 3 myxomas were found in the left atrium, and were removed successfully. No recurrence has been observed for 14 years after the operation. Three years after that, her 3rd child, 31-year-old-women, suffered from cerebral embolism and was also diagnosed as a left atrial myxoma. A friable myxoma was removed with the interatrial septum. She had no recurrence for 11 years after the operation. In patients with cardiac myxoma who have unusual biologic behavior, including familial myxoma, "complex" type myxoma must be suspected. We suggest that it is important to distinguish patients with "complex" type myxoma, because the recurrence rate is much higher in those than in patients with "sporadic" type myxoma.

Adult↗
PubMed1996

Radial artery from left subclavian artery in redo coronary artery bypass grafting.

In redo coronary artery bypass grafting a left anterior thoracotomy can be used, if necessary, to avoid a dangerous repeat median sternotomy. In 2 patients with a well-functioning left internal mammary artery graft to a left anterior descending artery attached to the sternum, a radial artery was used with the left subclavian artery as the blood source. This technique can be used successfully in selected cases when a left thoracotomy is advisable and an arterial graft is preferred to a saphenous vein.

Anastomosis, Surgical↗
PubMed1995

Repeat embolization of the side branch of the internal mammary artery graft by gelatin sponge particles and micro coils.

The internal mammary artery (IMA) is increasingly used as a coronary bypass conduit because of better long-term patency and improved prognosis as compared with venous grafts. Previous investigators have suggested that the "steal" of blood flow of the IMA graft via the subclavian artery or a persistent large side branch of the graft may lead to its thinning. However, only a few reports have described the embolization of a large side branch using a transcatheter procedure. We present a case of repeated embolization of a large lateral costal side branch of the left internal mammary arterial graft applying gelatin sponge particles and micro coils, as well as angioplasty to the graft conduit, with resulting easing of chest pain.

Aged↗
PubMed1995

Coronary artery reoperation through the left thoracotomy with hypothermic circulatory arrest.

BACKGROUND: The left thoracotomy approach to avoid injury of the patent old graft and the myocardium with mid sternal reentry at coronary artery reoperation. METHODS: The left thoracotomy approach was used in 13 patients. There were 11 men and 2 women with a mean age of 63 years, ranging from 39 to 75 years. Three patients were having their third coronary bypass operation. In 11 patients, distal anastomoses were performed under circulatory arrest with moderate hypothermia. In the other 2 patients, distal anastomoses were performed on a beating heart. No aortic cross-clamp was applied in all patients. The mean number of distal anastomoses was 1.8; the grafted vessels were 11 anterior descending, 3 diagonal, 8 circumflex, and 1 posterolateral coronary arteries. Used grafts were 17 saphenous veins, 4 left internal thoracic arteries, and 2 gastroepiploic arteries. Inflow sites of the free graft were descending aorta in 10 patients and left subclavian artery in 3 patients. RESULTS: All patients were alive and well at the mean follow-up of 16 months, and all grafts were patent. CONCLUSIONS: The left thoracotomy approach is safe and effective for reoperation on the left coronary artery system, and circulatory arrest is convenient and safe for performing distal anastomosis.

Adult↗
PubMed1995

Initial and subsequent angiographic outcome of percutaneous transluminal angioplasty performed on internal mammary artery grafts.

OBJECTIVE: To estimate the initial outcome and incidence of restenosis of angioplasty of internal mammary artery grafts in a retrospective study. METHODS: The study population consisted of 46 patients (48 lesions) who underwent first balloon angioplasty within the internal mammary artery graft. Most (37/48) were at the distal anastomosis. A few (8/48) were in the graft body. Six patients with the evidence of angiographic restenosis underwent a second angioplasty. RESULTS: The success rate and the restenosis rate of the first angioplasty was 73% and 30% respectively. Of the 34 patients (35 lesions) with a successful first angioplasty, 30 underwent follow up angiography with a restenosis rate of 30% (9/30). A second angioplasty was performed on six of the nine restenotic lesions, with a success rate of 83% and no restenoses. The percent diameter stenosis of the recipient native coronary artery was significantly greater in the restenosis group, at 75 (SD 27)% v 89 (17)%, p < 0.05. CONCLUSIONS: First angioplasty of 46 patients (48 lesions) within an internal mammary artery graft was performed with a success rate of 73% and a restenosis rate of 30% (follow up rate of 88%). The extent of the stenosis of the recipient native coronary artery may affect the restenosis rate.

Adult↗
PubMed1995

Development of an apparatus to measure plasma colloid osmotic pressure mounted on the extracorporeal hemodialysis circuit.

We newly developed an apparatus to measure colloid osmotic pressure (COP) of blood plasma continuously by hemodialysis (HD) or extracorporeal ultrafiltration method (ECUM) without any invasive procedure or blood sampling. The COP value measured by this apparatus highly correlated with the COP value calculated from the concentration of total protein of blood plasma (TP) sampled simultaneously (y = 21.182 + 0.96256x, r2 = 0.911). Measurement of the COP with this apparatus seems to be reliable.

Adult↗
PubMed1995

[Left thoracotomy approach for coronary reoperation].

We experienced reoperative coronary revascularization through a left thoracotomy in 12 patients between June 1992 and June 1994. All patients underwent grafting to the left coronary system except one, who underwent bypass procedure to the atrioventricular branch of the right coronary artery in addition to grafting to the left anterior descending artery, using the pedicled left internal thoracic artery, the gastroepiploic artery as a free graft, or a reversed saphenous vein graft. In one patient, revascularization was accomplished during temporary occlusion of the coronary artery without cardiopulmonary bypass. On the other hand, in 11 patients, cardiopulmonary bypass was used. Coronary bypass procedure was employed under the ventricular fibrillation with hypothermia in those but one, who underwent revascularization under the beating heart with cardiopulmonary support. All patients were hemodynamically stable in postoperative stage, and artificial ventilation time was not prolonged, with a mean time of 15.7 hours. Postoperative morbidity included reexploration for hemorrhage in one patient, convulsion in one, worsening of hemianopsia in one, ventricular arrhythmia in one, and wound complication in one, however, there were no hospital deaths. All patients underwent repeat coronary angiography, which revealed that all grafts were widely patient except one, which had inadequate flow due to diffuse narrowing. Based on these clinical results, we conclude that a left thoracotomy is a useful approach for reoperative coronary bypass procedures to reduce the surgical risk associated with a sternal reentry in properly selected patients.

Adult↗
PubMed1995

[Multiple systemic embolization from floating thrombus in left atrium].

A 66-year-old woman was referred to our hospital because of cerebral infarction, myocardial infarction and renal infarction. Further examination indicated that she was suffering from mitral valve stenosis with a floating thrombus in the left atrium. She underwent emergency mitral valve replacement and thrombectomy. The thrombus was attached to the left atrium by only four thin and weak strings and removed easily. We think that the thrombus was the precursor of a free-floating ball thrombus without stalk.

Aged↗
PubMed1995

[The inferior epigastric artery as a coronary artery bypass graft].

From January 1992 through December 1993, 31 patients underwent myocardial revascularization with the inferior epigastric artery (IEA) graft. There were one emergency case and four coronary reoperation cases. IEA grafts were taken down through the left side paramedian incision and dilated with papaverine hydrochloride solution. The distal anastomoses were made to left anterior descending (3 cases), diagonal (14 cases), obtuse marginal (9 cases), postero-lateral (I case) and right coronary artery (4 cases). The proximal anastomoses were made to the aorta (22 cases), the hood of a new vein graft (4 cases) and the hood of an old vein graft (4 cases). When IEA was not long enough to reach the ascending aorta, it was anastomosed to the internal thoracic artery (2 cases) or the gastroepiploic artery (1 case) graft. There was one hospital death, and early patency rate (within one month) was 90% (19/21). The postoperative angiography performed at 1.3 years or 2 years showed excellent IEA graft patency. These results suggested that the IEA is suitable as a coronary artery bypass graft. Further long-term patency must be evaluated.

Adult↗