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Biomedical subjects

H Suma

Publications and source records attributed to H Suma.

At least 127 records · Page 7Linked to original sources
PubMed1990

[Free arterial graft in coronary artery bypass surgery].

Free arterial graft of the internal mammary artery (IMA) and the gastroepiploic artery (GEA) has been utilized for coronary artery bypass grafting in 10 patients during 44 months period. There were 6 males and 4 females and age ranged 42 to 73 year old with the mean of 60.8 year old. Eight IMA and 2 GEA were used as a free graft. Sites of distal anastomosis of the free graft were 3 at anterior descending arteries, 3 at diagonal branches and 4 at circumflex arteries. Sites of proximal anastomosis of those grafts were ascending aorta in one, concomitantly utilized saphenous vein graft in 5 and in situ IMA graft in 4 patients. Mean number of grafts was 2.9 (2-5) and mean aortic cross clamp time was 56.2 minutes (16-90 minutes). There was neither operative death, nor perioperative myocardial infarction and intra-aortic balloon pumping was not required. Postoperative angiography was made in 9 patients within 3 postoperative months. Eight (89%) free arterial grafts were patent. Relief of angina was obtained in all patients. We concluded that the complete revascularization with only arterial graft can be achieved more widely by utilizing the free arterial graft with an acceptable patency.

Adult↗
PubMed1990

[Investigation of primary tissue failure in mitral bioprostheses].

A study was conducted on 118 Hancock (HX) porcine valves, 251 Carpentier-Edwards (CE) porcine valves, and the biological valves in children used in the mitral position. Twenty-three HX valves, twenty-seven CE valves, and all valves except one operative death in children were diagnosed as primary tissue failure (PTF). Freedom from PTF for HX valves was 70.1 +/- 6.0% at ten years and for CE valves was 45.7 +/- 17.0% at ten years, although for children it was calculated 0% at eight years (significantly poor results compared with adults). No relation was found between the degree of calcified cusps and the duration of PTF valves used. The ruptures and calcifications of the cusps were most commonly observed in commissure. The peeled off commissures were characteristic in CE valves. Three adults and two children died without reoperation caused by calcified stenotic valves. Since the risk of reoperation was higher in NYHA functional class four, we recommend earlier elective reoperation.

Adult↗
PubMed1990

[Results of sequential aorto-coronary bypass grafting using saphenous vein graft].

Seventy patients underwent sequential coronary artery bypass grafting with saphenous vein during 28 months period. Seventy eight sequential grafts comprising 165 distal anastomoses were performed. Early death was 2.9%. Postoperative angiographic evaluation within 6 months showed 86% patency of the 65 sequential grafts and 89% patency of the 136 distal anastomoses. The patency of anastomosis to left anterior descending artery (LAD), diagonal branch (Dx), obtuse marginal branch (OM), posterior lateral branch (PL), and posterior descending branch (PD) was 87% (13/15), 92% (36/39), 91% (40/44), 81% (26/32) and 100% (6/6), respectively. The patency of Dx-LAD, Dx-OM and OM-PL was 86% (12/14), 94% (15/16) and 76% (13/17), respectively. There was no significant difference in the patency rate according to the site of anastomosis and the inner diameter of the coronary artery. The patency of side to side anastomoses was 92% (65/71) which was not significantly different from that of the end to side anastomoses; 86% (56/65). These results showed sequential aorto-coronary vein grafting means to be effective for the complete coronary artery revascularization .

Aged↗
PubMed1990

[The gastroepiploic artery graft in coronary artery bypass surgery].

From March 1986 to October 1989, 91 patients underwent CABG using the right gastroepiploic artery (GEA) at Osaka Medical College and Mitsui Memorial Hospital. Including 14 females, the mean age was 57.9 years old ranged from 34 to 73 years old. Triple vessel disease and left main disease occupied over 90% of the patients. There were 5 emergency operations and 6 reoperations. Associated serious diseases were; renal failure with hemodialysis in 2 pts., familial hyperlipidemia in 5 pts., severe atherosclerotic ascending aorta in 8 pts., arteriosclerosis obliterance in 3 pts., and each one of abdominal aortic aneurysm and idiopathic thrombocytopenic purpura. The internal thoracic artery (ITA) graft was concomitantly utilized in 96% of the patients. Single ITA in 60 pts., double ITA in 23 pts. and sequential ITA in 5 patients. Saphenous vein graft was used in 58 patients and remaining 33 patients were operated without leg wound. The mean number of distal anastomoses was 3.3 ranged from 1 to 5, and the mean number of arterial grafts was 2.5 ranged from 1 to 4. The mean aortic cross clamp time and cardiopulmonary bypass time was 62.8 minutes and 113.6 minutes, respectively. Sites of GEA anastomosis were; 4 anterior descending, 3 diagonal, 11 circumflex and 73 right coronary arteries. There were 86 in situ grafts mostly for the right coronary arteries, and remaining 5 GEAs were used as a free graft to bypass the left coronary arteries. On the contrary, ITA was used to bypass the left coronary artery system preferentially. There was 3 combined procedures; splenectomy, abdominal aorta replacement, and ascending aorta to bifemoral artery bypass in each one patients. Three patients including one emergency case died within 30 days after surgery. Two were cardiac and one was renal failure. Other 2 patients died of stroke at late period. New Q wave infarction was noted in 2 patients. Relief of angina was obtained in 98% of survivors. The patency rate of the GEA graft was 97% in 61 grafts restudied within 6 postoperative months, which was identical with that of the ITA graft, that is 97% of 76 grafts. In conclusion, the GEA has several advantages as a coronary artery bypass graft such as similarity in size to the coronary artery, rare arteriosclerosis, feasibility of in situ graft, and no gastric complication. Its flow capacity is studying now and favourable results are being obtained. The final problem, its long term patency, will be resolved in future. GEA is a promising conduit for the coronary bypass surgery.

Adult↗
PubMed1989

Myocardial revascularization with combined arterial grafts utilizing the internal mammary and the gastroepiploic arteries.

Coronary artery bypass grafting with a combined arterial graft using both the internal mammary artery and the right gastroepiploic artery was performed in 22 patients during a 21-month period. There were 17 men and 5 women ranging in age from 34 to 73 years (mean age, 53.4 years). Three patients were having a reoperation, and 2 patients had no segment of long saphenous vein available. Twelve patients were less than 55 years old. The mean number of distal anastomoses including vein grafts was 3.2 and the mean number of arterial grafts was 2.5 per patient. The mean aortic cross-clamp time was 63.8 minutes and the mean cardiopulmonary bypass time was 116.7 minutes. There was 1 early and 1 late death. The other 20 patients are alive without angina. Studied within 3 postoperative months, graft patency was 95% (19/20) in internal mammary artery and 93% (14/15) in gastroepiploic artery grafts. It is concluded that the combined arterial graft can be used safely and effectively, and its application facilitates complete revascularization with more arterial and fewer vein grafts.

Adult↗
PubMed1989

Combined coronary revascularization and splenectomy.

Idiopathic thrombocytopenic purpura is rarely associated with coronary artery disease. In this report, we describe the successful surgical management of a patient with idiopathic thrombocytopenic purpura and angina pectoris.

Adult↗
PubMed1989

Coronary artery bypass grafting in patients with calcified ascending aorta: aortic no-touch technique.

To perform coronary artery bypass grafting safely for patients with calcified ascending aorta, an "aortic no-touch technique," which consisted of (1) maximal utilization of in situ arterial grafts (2) fibrillatory arrest without aortic cross-clamp, (3) left ventricular venting through the right superior pulmonary vein, and (4) femoral artery perfusion, was attempted in 3 patients. All were men, aged 64, 70, and 56 years, respectively, with triple-vessel disease with severe atherosclerotic lesion in the ascending aorta. Bilateral internal mammary arteries and the right gastroepiploic artery were used in all patients. All patients survived without evidence of perioperative myocardial infarction or cerebrovascular accident.

Aged↗
PubMed1989

Combined revascularization of coronary and femoral arteries: a proposed alternative.

Two patients with both coronary artery disease and leg ischemia were successfully treated with a combined revascularization procedure. Coronary arteries were bypassed with in situ internal mammary artery grafts, and bilateral femoral arteries were bypassed with expanded polytetrafluoroethylene grafts descended from the ascending aorta through the preperitoneal abdominal wall tunnel. Both patients recovered well and experienced no angina or claudication.

Aged↗
PubMed1989

A case of successful coronary artery bypass grafting in a patient with angina pectoris and hypothyroidism.

There is a clinical dilemma in the treatment of patients with hypothyroidism and coronary artery disease; excess thyroid hormone administration may exacerbate anginal symptoms, and yet inadequate thyroid replacement may induce congestive heart failure. A case of successful coronary artery bypass grafting in a patient with angina pectoris and hypothyroidism is described in this paper. A 55 year-old woman with this complication initially received thyroid replacement therapy under strict monitoring. Forty days after the start of the thyroid replacement therapy, serum levels of thyroid hormone had reached the normal range, and then coronary artery bypass grafting was successfully performed. She recovered without any complications, and is now free from chest pain in spite of thyroid replacement therapy.

Angina Pectoris↗
PubMed1989

Results of multiple coronary artery bypass grafting in Japanese patients.

Multiple coronary artery bypass grafting with more than 4 grafts has been carried out in 64 Japanese patients during a 3.5 year period. There were 55 males and 9 females; ages ranged from 34 to 75 with a mean of 58.9 years old. Double, triple and left main disease were noted in one (2%), 54 (84%) and 9 (14%) patients, respectively. There was 54 (84%) stable and 10 (16%) unstable angina pectoris, and 28 (44%) patients had previous myocardial infarction. The saphenous vein graft was used for all patients with a preferential use of sequential graft (84%). The internal mammary artery graft was used in 55 (86%) patients and the right gastroepiploic artery graft was used in 6 (9%) patients. There were 2 (3.1%) early and 2 (3.1%) late deaths. New Q wave was noted in 2 (3.1%) patients and intraaortic balloon pumping was required in 3 (4.7%) patients. The mean number of grafts was 4.4 ranged from 4 to 7, and the mean aortic cross clamp time and cardiopulmonary bypass time was 74.5 min and 134.3 min, respectively. Graft patency within 6 postoperative months was 86% (120/140) in saphenous veins, 96% (52/54) in internal mammary arteries and 100% (5/5) in gastroepiploic arteries. Relief of angina was noted in 58 (96.7%) of 60 survivors. It was concluded that the increase in the number of coronary artery anastomoses does not increase surgical risk and favorable outcome and acceptable graft patency can be obtained by multiple grafting for patients with severe multivessel coronary artery disease.

Adult↗
PubMed1989

[Diffuse narrowing of the internal mammary artery graft--the thinning phenomenon].

Diffuse narrowing of the internal mammary artery graft (IMAG), the thinning phenomenon, was found in 8 (6.7%) out of 120 IMAGs underwent postoperative angiography. There were 6 males and 2 females, and mean age was 55.3 ranged from 37 to 70 year-old. There was no significant correlation with hyperlipidemia, diabetes mellitus or hypertension. Grafted coronary arteries were 6 anterior descending, one diagonal and one circumflex arteries. Diameter of them was 1.5 mm in one and 2 mm in 7. severity of stenosis of proximal coronary artery was 100% in one, 90-99% in one and less than 90% in 6. Undivided sizable costal or pericardial branches were found in 4 patients. All eight patients were alive without angina, although mild positive stress EKG changes were noted in two patients. In conclusion, a high resistance state such as a good competitive native coronary flow was thought to be the most important factor for the diffuse narrowing of IMAG, and close follow up should be needed because its outcome is still unknown.

Adult↗
PubMed1989

[Clinical experience of bovine internal mammary artery graft (BIOFLOW) for coronary artery bypass surgery].

Bovine internal mammary artery graft (BIOFLOW: BIOVASCULAR INC. Netherlands) has been used for coronary artery bypass grafting (CABG) in 8 patients since May 1988 at Osaka Medical College Hospital. There were 4 males and 4 females. Mean age was 66.9 year-old ranged from 62 to 72. Two were emergency CABG and other six had inadequate saphenous veins. The internal mammary artery and/or the saphenous vein were concomitantly used in all patients. Number of grafts was 2 to 6 with the mean of 2.9 and BIOFLOW (phi 3 mm) was anastomosed to 2 left anterior descending arteries and 6 right coronary arteries, the mean graft flow of BIOFLOW was 72.5 ml/min ranged from 52 to 120 ml/min. One patient died of ventricular arrhythmia on 5 postoperative day. There was no new Q wave infarction. Postoperative angiogram within 2 months showed 4 of 5 BIOFLOW grafts were patent, and no stenosis was found in those patent grafts. All survivors returned to home with a freedom from angina. From our experience, although the number was small and the follow-up period was short, BIOFLOW can be expected as an conduit of choice for CABG when the saphenous vein was not available and the internal mammary artery and the gastroepiploic artery were not enough to accomplish the complete revascularization.

Aged↗
PubMed1989

[Coronary artery bypass grafting using gastroepiploic artery].

Since March 1986, coronary artery bypass grafting (CABG) by utilizing the right gastroepiploic artery (GEA) has been performed in 60 patients during 3 year period. There were 52 males and 8 females, and age ranged from 34 to 73 year old with the mean of 56.2 year old. Triple vessel disease and the left main disease involved 90% of the patients. There were two patients under hemodialysis for chronic renal failure, one patient with idiopathic thrombocytopenic purpura, one patient with aneurysm of the abdominal aorta, and two patients with arteriosclerosis obliterance, preoperatively. Five patients were second CABG. GEA was used as an in-situ graft in 57 patients and as a free graft in 3 patients and was anastomosed to 3 left anterior descending, 3 diagonal (all "free" graft), 5 circumflex, and 49 right coronary arteries. To bypass the other coronary arteries, the internal mammary artery graft (unilateral 38, bilateral 20, sequential 5) with or without saphenous vein graft was used. The mean number of distal anastomoses was 3.3 (1-5) and the mean number of arterial graft anastomoses was 2.4 (1-4) per patient with the mean aortic cross clamp time of 62.4 minutes (23-137 minutes) and the mean cardiopulmonary bypass time of 120.8 minutes (69-210 minutes). Splenectomy, Y graft replacement of the abdominal aorta, and ascending aorta-bifemoral bypass were concomitantly carried out in each one patient. Two patients (3.3%) died of renal and cardiac failure within 30 postoperative days. One patient (1.7%) died of stroke lately. New Q wave was noted in 2 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Internal mammary artery grafting to the circumflex coronary artery].

The in-situ left internal mammary artery (LIMA) was anastomosed to the circumflex coronary artery (Cx) in 20 patients. The right internal mammary artery, the saphenous vein and the right gastroepiploic artery were also utilized to bypass the other coronary arteries. Sequential LIMA grafting to the diagonal branch and CX was performed in 2 patients. The sites of LIMA anastomosis were 15 obtuse marginal branches and 5 posterior lateral branches. All LIMA-Cx anastomoses were performed with single 8-0 polypropylene continuous suture technique. Mean number of distal anastomosis was 3.1 ranged from 2 to 4. Mean aortic cross clamp time was 68.5 minutes ranged from 42 to 87 minutes, and mean cardiopulmonary bypass time was 116.6 minutes ranged from 73 to 167 minutes. One patient died of renal failure at 22nd postoperative day, and the other patients were alive with relief of angina. New Q wave was noted in 1 patient. Postoperative angiogram at mean 2.0 months showed 100% patency of LIMA in restudied 12 patients. We concluded that the in-situ LIMA grafting to Cx system can be done with acceptably low mortality and excellent patency rate, and its utilization is particularly desirable in younger patients.

Adult↗
PubMed1989

Efficacy of coronary artery bypass surgery with gastroepiploic artery. Assessment with thallium 201 myocardial scintigraphy.

This study describes the efficacy of the right gastroepiploic artery (GEA) as graft material for coronary artery bypass grafting (CABG) as assessed by exercise thallium 201 myocardial scintigraphy in eight patients (age, 59.4 +/- 9.35 years [mean +/- SD]) who underwent CABG with the GEA graft in the past 2 years. Planar and single-photon-emission computed tomographic (SPECT) images were obtained during and 3 hours after exercise. Planar images were evaluated quantitatively with the percentile-washout method, and SPECT images were evaluated qualitatively with a bull's-eye, polar-coordinate map. All patients had triple-vessel disease, and in situ GEAs were anastomosed to the right coronary artery in seven patients and to the left anterior descending coronary artery in one. The internal mammary artery graft was concomitantly used in all patients. The mean number of grafts per patient was 3.0 (range, 2-4). Preoperative exercise testing could not be performed in two patients because of emergency operation. By qualitative assessment with the polar-coordinate map, four patients showed improvement, one did not show any change, and one became worse due to perioperative myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Effects and causes of additional vein graft following IMA grafting in CABG].

The use of the internal mammary artery (IMA) in coronary artery bypass grafting (CABG) is recently common. The authors have been actively using the IMA in graft of the anterior descending artery (LAD). However, there are cases in which the onset of ventricular fibrillation or low cardiac output occurred around weaning from CPB or chest closure. We have experienced 8 such cases, 3 of which expired due to LOS or renal failure. When the IMA is to be used in CABG, one must be extremely cautious in next cases. 1. Cases of 3 VD with good EF. 2. Cases of OMI in RCA area or not to be expected complete revascularization in inferior wall. 3. Cases in the absence of collateral between R and L coronaries. In such cases, IABP should be carried out and anastomosed with an additional saphenous vein graft (SVG) at that coronary artery.

Angina, Unstable↗
PubMed1989

[Sequential internal mammary-coronary artery bypass].

A total of ten patients have undergone sequential bypass grafting of the internal mammary artery (IMA) to the coronary arteries at Osaka Medical College. Operative procedures included left IMA bypass to the left anterior descending (LAD) artery and its major diagonal branch in six patients; to the obtuse marginal branch and diagonal branch in three patients; and to the first and the second diagonal branches in one patient. The right internal mammary artery was concomitantly utilized in 4 patients and saphenous vein graft was also utilized in 6 patients. Postoperative angiographic studies were performed in nine patients within 6 months after operation and in all 18 sites of IMA anastomoses, the IMA sequential grafts were patent. Since sequential IMA-coronary bypass technique means the increase of arterial graft, we believe that this technique should be used for multivessel coronary revascularization especially in younger patients.

Adult↗