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Biomedical subjects

H Suma

Publications and source records attributed to H Suma.

At least 145 records · Page 8Linked to original sources
PubMed1989

[Coronary artery reoperation utilizing "free" gastroepiploic artery].

A 57-year-old female underwent coronary artery bypass reoperation successfully by utilizing the free gastroepiploic artery (GEA) graft in combination with the in situ left internal mammary artery (IMA) graft. The left IMA was anastomosed to the left anterior descending artery and the "free" GEA was anastomosed to the left IMA proximally and to the first diagonal branch distally. The patient recovered well with a disappearance of angina. Postoperative angiogram at 6 weeks showed good patency of both grafts and improvement of left ventricular contraction was obtained. Thus, GEA can be utilized not only as an "in situ" graft, but also as a "free" graft, effectively.

Arteries↗
PubMed1989

[Poststernotomy mediastinitis treated by early surgical intervention].

Poststernotomy mediastinitis in 67-year-old female was successfully treated by early operation after coronary artery revascularization using bilateral internal mammary arteries and gastroepiploic artery. Wider debridement including sternum, ribs, mediastinal fat and connective tissues, and transfer of rt-pectoralis major muscle flap into the mediastinum to obliterate the dead space was performed. The sternal wound was primarily closed without postoperative irrigation. The sternum was stayed open without using any artificial substitute. In conclusion, the early diagnosis and operation is the key for successful treatment of poststernotomy mediastinitis. Wider debridement including sternum and ribs with perioperative lavage by diluted povidone-iodine solution and antibiotic solution should be done aggressively, and the transfer of the major pectoral muscle flap and skin closure without postoperative irrigation is an effective method of choice. Additional reconstruction of anterior chest wall should be considered if necessary, when the inflammatory process is subsided.

Aged↗
PubMed1989

[A clinical study of diltiazem administration using cold glucose-insulin-potassium cardioplegic solution--comparison between diltiazem cardioplegia and diltiazem pretreatment].

A recent idea of myocardial injury during open heart surgery is thought to be caused by the intracellular calcium overload. So, one possibility for improving myocardial protection is expected on the blocking agents of transmembrane calcium movements. This study was designed to clarify the effect of Diltiazem, a kind of calcium blocking agents, on myocardial protection in terms of hemodynamics and plasma Diltiazem concentration. 38 patients who underwent coronary artery bypass grafting using glucose-insulin-potassium cardioplegic solution (GIK) were divided into three groups Control (CO) group: no Diltiazem administration. Diltiazem cardioplegia (DC) group: GIK containing 7.5 mg/l Diltiazem was used. Diltiazem pretreatment (DP) group: Diltiazem was administered intravenously 1.5 micrograms/kg/min before operation to after operation continuously. Plasma Diltiazem concentration was constantly kept at about 150 ng/ml during 24 hours after surgery in DP. On the contrary, in DC, the level was very high (10,000 ng/ml) during aortic cross clamp but decreased about 50 ng/ml at 3 hours after surgery, and Diltiazem was not detected in CO. DC included many cases of bradycardia required pacing, however, it diminished as plasma concentration decreased. Aid of catecholamin administration was reasonable in three groups. DP and DC included many cases of commendable cardiac function in terms of cardiac index, systemic vascular resistance and left ventricular work during acute stage of surgery, and there were no coronary spasm and perioperative infarction. It is concluded that Diltiazem is effective to keep good cardiac function after reperfusion, and combined (Diltiazem pretreatment--1.5 micrograms/kg/min drip infusion-and Diltiazem cardioplegia-total dose 150-300 micrograms/kg) administration should be advisable.

Calcium Channel Blockers↗
PubMed1988

Augmentation of coronary bypass graft flow induced by dipyridamole and its relation to bypass graft patency.

To evaluate the effect of dipyridamole on coronary bypass graft flow, 10 mg of dipyridamole was injected intravenously, during the measurement of graft flow, at the time of surgery. Its concentration in serum was measured and compared with that after oral administration. In 50 individual vein grafts performed on 35 patients, graft flow increased from 65 +/- 37 to 96 +/- 55 ml/min (p less than 0.001) after the dipyridamole injection and the arterial pressure decreased slightly. In 40 grafts whose graft flow was increased by more than 10 ml/min by dipyridamole, the patency rate (at 5 weeks) was 98 per cent, whereas that of the 10 other grafts, which responded poorly, was only 50 per cent (p less than 0.01). The serum concentration of dipyridamole, 3 minutes after intravenous injection, was 1.46 +/- 0.68 micrograms/ml, while the level of orally administered dipyridamole, in 3 groups of patients who were given 50 mg, 75 mg and 100 mg, three times a day, respectively, was steady, being 0.68 +/- 0.20 micrograms/ml, 1.43 +/- 0.41 micrograms/ml and 1.73 +/- 0.50 micrograms/ml, 2 hours following ingestion. We concluded that intravenous dipyridamole increases the graft flow and that a better patency is obtained in those grafts in which the graft flow is increased by more than 10 ml/min. It is also expected that routine doses of oral dipyridamole possibly increase the graft flow after coronary bypass surgery.

Administration, Oral↗
PubMed1988

Coronary artery bypass grafting by utilizing the internal mammary artery graft in 100 Japanese patients.

The internal mammary artery (IMA) grafting for myocardial revascularization was performed in 100 Japanese patients during a three-year period. There were 86 males and 14 females with the mean age of 58 +/- 9 (37 approximately 75 year-old). Unilateral IMA was used in 88 patients and bilateral IMA was used in 12 patients. Sequential IMA grafting was performed in 5 patients. The sites of IMA grafting were 91 left anterior descending arteries (LAD), 16 diagonal branches, 8 circumflex arteries and 2 right coronary arteries. Saphenous vein or gastroepiploic artery was concomitantly used to bypass the other coronary arteries in 90 patients. The number of distal anastomosis ranged from 1 to 6 and the mean was 2.8 per patient. Two patients died within 30 days and one patient died at 3 months after surgery. Perioperative myocardial infarction was noted in 3 patients. Symptomatic relief was obtained in 94 (97%) of 97 survivors. The patency of the IMA graft at mean 2.2 postoperative months was 97% (58/60) in LAD, 100% (14/14) in the diagonal branch, 100% (5/5) in the circumflex artery, 100% (1/1) in the right coronary artery, and 98% (78/80) in over-all grafted coronary arteries. Pre- and postoperative exercise thallium scintigraphy in 13 patients, who received the IMA graft to severely stenosed LAD, showed significant improvement of the washout ratio (from 33.1 +/- 16.9% to 47.4 +/- 14.8%) which was nearly equivalent to that of the saphenous vein graft to LAD (from 24.8 +/- 6.2% to 48.1 +/- 6.6%, n = 7).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Angiographic comparison of the internal mammary artery graft and the saphenous vein graft within 2 months and 6 to 12 months after coronary artery bypass surgery.

Angiographic status of the saphenous vein graft (SVG) and the internal mammary artery graft (IMAG) anastomosed to the left anterior descending artery were compared at two different postoperative periods; - within 2 months and at 6 to 12 months after the operation. In 50 SVGs and 35 IMAGs which were studied at the early postoperative period, the rate of intact, stenosed and occluded grafts were almost the same in these two kinds of grafts. However, in 35 SVGs and 25 IMAGs which were studied at the later period, the stenosis of SVG increased significantly while IMAG remained intact. The rate of intact, stenosed and occluded grafts at postoperative 6 to 12 months were 71%, 23% and 6% in SVG, and 88%, 8% and 4% in IMAG, respectively. Considering the better angiographic quality of IMAG, use of IMAG to bypass the most important coronary artery should be considered especially when the patients are younger.

Constriction, Pathologic↗
PubMed1988

[Arterial grafts for myocardial revascularization; experience of 65 internal mammary artery and gastroepiploic artery graftings].

From November, 1984, to February 1987, internal mammary artery (IMA) and gastroepiploic artery (GEA) graftings to coronary arteries were performed in 65 patients. Of these patients, 58 unilateral IMAs, 6 bilateral IMAs, 2 GEAs were utilized. The hospital mortality was 3.2% but no cardiogenic death occurred. Fifty-eight (89%) patients became asymptomatic after surgery. Postoperative angiography performed from 1 to 3 months after operation showed excellent patency in 57 (96%) IMAs and 2 (100%) GEAs. On the other hand, the patency of saphenous vein graft done at the same period were 88%. GEAs were used for 2 reoperated cases and revealed good patency and relief of symptoms without surgical complication. Cavitron ultrasonic surgical aspirator (CUSA) was used to dissect IMA from the chest wall, which was useful to shorten the operative time. In conclusion, arterial grafts, such as IMA and GEA were thought to be excellent coronary bypass conduits even for the small Japanese patient.

Adult↗
PubMed1988

Internal mammary artery grafting in patients with smaller body structure.

The results of internal mammary artery grafting in 50 patients with a body surface area less than 1.6 m2 were compared with those in 54 patients with a larger body surface area. Age (58.8 +/- 8.2 versus 54.9 +/- 10.3 years old) and prevalence of female gender (28% versus 4%) were significantly different between the group of patients with a small body surface area and the group with a large body surface area, respectively. However, the prevalence of unstable angina, previous myocardial infarction, extent of coronary artery disease, and preoperative ejection fraction was not significantly different between the two groups. The mean number of distal anastomoses was 3.0 and 2.8, and the mean duration of aortic occlusion was 65.6 +/- 23.0 minutes and 59.5 +/- 21.7 minutes in the small and large body surface area groups, respectively (not significant). The mean free flow rate of the internal mammary artery was 65.6 +/- 16.8 ml/min in the small body surface area group and 78.0 +/- 21.6 ml/min in the large body surface area group (p less than 0.05). The diameters of the anterior descending and the circumflex arteries were significantly smaller in the small body surface area group. Two patients (4%) died within 30 days of operation and one patient died later in the small body surface area group, whereas no death was noted in the large body surface area group (not significant). No significant differences were found in the incidence of aortic balloon pumping, perioperative myocardial infarction, and serious postoperative complications between the two groups. Symptomatic relief was equally good in both groups (92% and 96%). The patency rate of the internal mammary artery was 95% (42/44) in the small body surface area group and 100% (48/48) in the large body surface area group within 1 year, mean 2.3 +/- 2.4 months. In conclusion, internal mammary artery grafting can be performed safely and effectively even in patients with small body structure. Though the blood flow of the internal mammary artery and the size of the coronary arteries were smaller in patients with small body structure, excellent patency of the internal mammary artery graft and satisfactory symptomatic relief can be expected.

Blood Flow Velocity↗
PubMed1987

Vein holder for coronary bypass surgery.

Two types of vein holder were designed to facilitate coronary bypass surgery. One is designed for vein graft-to-coronary artery anastomosis and is particularly useful for the side-to-side anastomosis in sequential grafting. The other is designed for vein graft-to-aorta anastomosis and enables anastomosis by one surgeon. The vein holder holds the vein graft in a three-dimensional position without the need of forceps, which protects the vein graft wall from crush injuries caused by vascular forceps.

Blood Vessel Prosthesis↗
PubMed1987

Application of ultrasonic aspirator for dissection of the internal mammary artery in coronary artery bypass grafting.

The low-power ultrasonic aspirator was used for the dissection of the internal mammary artery (IMA) in 20 patients undergoing coronary artery bypass grafting. Harvesting time was shorter and the amount of bleeding was less than with the ordinary method. The short-term patency rate (1 to 6 months) for those IMA grafts was 95% (19 of 20 remained patent). These results have encouraged us to use the ultrasonic aspirator routinely for IMA dissection.

Coronary Artery Bypass↗
PubMed1987

Coronary artery bypass grafting by utilizing in situ right gastroepiploic artery: basic study and clinical application.

The right gastroepiploic artery (GEA) was studied angiographically and histologically to determine its suitability for coronary artery bypass grafting. One hundred celiac angiograms demonstrated that the right GEA has the appropriate size (diameter less than 1.5 mm, 4%; 1.5 to 2 mm, 29%; more than 2 mm, 67%) and length (less than half of the greater curvature, 5%; more than half of the greater curvature, 95%; more than two-thirds of the greater curvature, 34%) for use as an in situ graft. A stenotic lesion of a GEA was observed in only 1 angiogram. Histological examination of a right GEA from 5 patients who had undergone gastrectomy demonstrated no evidence of arteriosclerosis. Encouraged by these results, we performed a coronary artery bypass reoperation utilizing an in situ right GEA graft in 2 women. Postoperative angiograms showed good patency of those grafts. The patients recovered well and were free from angina.

Adult↗