[Clinical evaluation of the St. Jude medical prosthesis in tricuspid position].
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Biomedical subjects
Publications and source records attributed to Y Sezai.
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Two hundred and ninety patients with ischemic heart disease and two hundred and sixty one patients with valvular heart disease have been operated upon in our department. Combined valvular and coronary artery surgery was carried out in 19 cases, coronary artery and peripheral vascular surgery was carried out in 7 cases, and tricuspid valve replacement with SJM was carried out in 20 cases. Early mortality rate of combined valvular and coronary artery surgery was 26%, and late mortality 21%, however, only 3 cases (15.8%) died of LOS. Mortality rate of combined coronary artery and peripheral vascular surgery was 43%, however 1 patient died of LOS. Mortality rate of TVR with SJM was 15% which was rather low in comparison with other valves. A patient who underwent simultaneous surgical treatment of valvular or peripheral vascular disease, and coronary artery disease, ran almost the same risk of LOS as patients without ischemic heart disease. However, myocardial protection was important for these patients because of severe LV dysfunction and myocardial hypertrophy. There is not yet an ideal artificial valve for TVR. At present, SJM is the best available valve in terms of design and hemodynamics.
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Use of a vascular pedicled temporoparietalis muscle flap resurfaced with a full-thickness skin graft from the opposite ear, instead of less-than-favorable skin coverage, is advocated to achieve more satisfactory aesthetic results in total ear reconstruction handicapped by the presence of scarred local skin. The technical feasibility of the procedure and the authors' experiences in the past 9 years are described.
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Two hundred and thirteen patients underwent surgical treatment for coronary artery disease from 1968, May to 1983, Feb. at our Department. Clinical diagnosis was stable angina in 55 patients, unstable angina in 47, angina with complication in 9, myocardial infarction in 54, and post-infarction complication in 48. Two hundred consecutive postoperative patients were evaluated. There were 11 late deaths occurred including 4 cardiac deaths in origin. Causes of late cardiac deaths were sudden death in 2 patients and cardiac decompensation in 2 patients. Reinfarction was seen in 1 out of 2 sudden deaths. This case underwent only left ventricular aneurysmectomy without A-C bypass grafting. Preoperatively, 49.2% of the patients were in NYHA 2, 34.8% in NYHA 3, and 15.9% in NYHA 4, but postoperatively 86.3% in NYHA 1 and 13.7% in NYHA 2. Reoperative surgical indications were native coronary progression in 1 patient, graft obstruction in 1, and ascending aortic aneurysm in 1. Surgical treatment of coronary arterial disease has still many problems to be solved, especially in patient with cardiogenic shock, multi-vessel disease, cerebral vascular disease, abdominal aortic aneurysm and patient of old age. But, we believe the surgical treatment will make much progress with development of myocardial preservation, assisted circulation, membrane oxygenator and simultaneous operative techniques including complete revascularization.
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