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Biomedical subjects

Y Wanibuchi

Publications and source records attributed to Y Wanibuchi.

At least 55 records · Page 3Linked to original sources
PubMed1994

[Reoperative coronary revascularization without cardiopulmonary bypass].

We report a case of successful reoperation of coronary revascularization without cardiopulmonary bypass. The patient was a 62-year-old man, who had undergone coronary artery bypass grafting (CABG) to the LAD and CX with two saphenous vein grafts (SVG) for the left main lesion 12 years before. He required reoperation for unstable angina due to progressive ischemic heart disease and the diseased SVG. Preoperative coronary angiogram revealed total occlusion of major 3 branches and the diseased SVG to the LAD. The reoperation was performed without cardiopulmonary bypass through the repeated median sternotomy for revascularization of the LAD and RCA. The left internal thoracic artery and the gastroepiploic artery were anastomosed to the LAD and RCA under the beating heart without any hemodynamic or electrocardiographic deteriorations. The operation was uneventfully finished in 3 hr 40 min. without the use of blood products. Postoperative angiogram showed both new grafts were widely patent, and he was discharged 14 days after the operation without angina. We also performed 4 other cases of reoperative CABG without cardiopulmonary bypass, and conclude that this technique is a safe and effective alternative in a carefully selected group of patients for reoperative CABG to reduce several technical problems related to coronary reoperation.

Abdominal Muscles↗
PubMed1994

[The second coronary reoperation via the left thoracotomy without cardiopulmonary bypass].

A 75-year-old female who had underwent coronary artery bypass grafting (CABG) reoperation 2 years before was readmitted because of unstable angina. Two arterial grafts and one saphenous vein graft (SVG) were all occluded one and half year after the primary operation. The second operation was approached via the repeated sternotomy. LAD and RCA were revascularized with a Y-shaped SVG which had only one inflow. Coronary angiogram revealed stenosis of LMT and RCA and occlusion of the inflow of the Y-shaped SVG. We performed the 3rd CABG via the left thoracotomy without cardiopulmonary bypass for revascularization of the LAD area. A new SVG was anastomosed from the descending aorta to the old SVG just proximal to the anastomotic site with LAD. Local coronary occlusion time was 7 min without any hemodynamic or electrocardiographic deteriorations. The operation was successfully performed in 3 hr 55 min. The patient recovered well uneventfully. Postoperative angiogram showed that the new SVG was adequately patent and she was discharged without angina. We conclude that CABG without cardiopulmonary bypass via the left thoracotomy is an useful alternative to decrease mortality and morbidity for reoperative myocardial reveascularization.

Aged↗
PubMed1994

[Two cases of coronary artery bypass grafting using great saphenous vein grafts in reversed Y-shaped for the atherosclerotic ascending aorta].

Coronary artery bypass grafting (CABG) was performed using saphenous vein grafts anastomosed in reversed Y-shaped in two patients because of the atherosclerotic ascending aorta. Postoperative course was uneventful, however, the common part of reversed Y-shaped grafts was occluded in both patients within two years after operations. The arms of reversed Y-shaped grafts were patent, and played a role of major collateral between LAD and RCA. They were treated successfully with reoperation in one patient and PTCA in another.

Aged↗
PubMed1994

[Late cardiac tamponade after open heart surgery].

59 cases of late cardiac tamponade following open heart surgery were studied. The incidence was 2.1%. Postoperative prolonged heart failure, anticoagulants, and blood in the pericardium left undrained may play a role in its pathogenesis. Echocardiography was the sure method of diagnosis. Insertion of a drainage tube into the pericardium through the subxiphoid approach was effective with minimal invasion and a treatment of choice.

Adolescent↗
PubMed1993

The right gastroepiploic artery graft. Clinical and angiographic midterm results in 200 patients.

From March 1986 to September 1991, the right gastroepiploic artery has been used for coronary artery bypass grafting in 200 patients (171 male and 29 female patients, mean age 58 years, range 6 to 80 years. They were followed up from 6 to 70 months with a mean of 27 months. There were 16 reoperations and 176 patients had triple vessel or left main disease. The gastroepiploic artery (182 in situ and 18 free grafts) was anastomosed to 11 anterior descending, 3 diagonal, 26 circumflex, and 160 right coronary arteries. The internal thoracic artery was concomitantly used in 192 patients. The mean number of distal anastomoses was 2.3 with arterial grafts and 3.3 including additional saphenous vein grafts. Postoperative angiography was performed in 152 patients within 6 months after the operation (mean 2 months) and after the operation second angiograms were done sequentially 1 to 5 years (mean 2 years) after the operation in 40 patients. There were 6 early and 4 late deaths. A new Q wave was noted in 4 patients. Duration of the operation and postoperative complications did not increase with the use of the gastroepiploic artery. Relief of angina was noted in 186 patients. Gastroepiploic artery graft patency was 95% (144/152) in the early postoperative period and 95% (38/40) in the late postoperative period. Percutaneous transluminal coronary angioplasty was done successfully through the in situ gastroepiploic artery graft for anastomotic stenosis in four cases. In stress myocardial scintiscans, performed sequentially preoperatively and in the immediate, 1-year, and 2-year postoperative periods in 11 patients, washout rate of the gastroepiploic artery-grafted area improved from 35% +/- 10% to 45% +/- 15% (p < 0.05) and was maintained to 43% +/- 6% and 48% +/- 9% at respective periods. In conclusion, the gastroepiploic artery is a suitable conduit for coronary artery bypass grafting in terms of low surgical risk, high patency rate, and excellent patient outcome.

Adolescent↗
PubMed1993

[Long-term result of surgical patients with ischemic heart disease 70 years of age and older].

This is a report of long-term follow-up of patients 70 years of age and older who underwent operations for ischemic heart diseases. (1) Two of them died in this follow-up period, one due to pneumonia seven months postoperatively, another due to lung cancer 20 months after operation. Actuarial survival rate was 96.8% at one year, 93.3% between two and five years. (2) Event-free rate was 80.6% at one year, 70.1% at two years, and 61.1% between three and five years. (2) Although 21 patients were classified in grade 0 (normal activity) of performance status, seven were classified between grade 2 and 4. We concluded that long-term results were good in surgical patients 70 years of age and older with ischemic heart disease.

Actuarial Analysis↗
PubMed1993

[Two episodes of fatal ventricular arrhythmia associated with use of electrosurgical unit during redo MVR procedure].

We report a case of ventricular fibrillation in the first episode and ventricular tachycardia in the second episode that occurred with use of electrosurgical unit during redo MVR procedure. Both arrhythmia occurred five to ten seconds after application of the electrosurgical knife in the coagulation mode to the sternal periosteum. The patient was immediately resuscitated with return to sinus rhythm using direct-current electroshock. In the literature, it was reported that large direct-current potentials were generated during electrosurgery and that these potentials increased with increasing sparking at the active electrode. Care should be always taken because they may cause fatal ventricular arrhythmia.

Adult↗
PubMed1993

[Hemodynamic situation immediately after cardiopulmonary bypass in cases of coronary artery bypass grafting (CABG) using both bilateral internal thoracic arteries (ITAs) and right gastroepiploic artery (GEA)].

Hemodynamic situation immediately after cardiopulmonary bypass was studied in cases of CABG using bilateral ITAs and right GEA. Though cardiac output was kept greater than 4.0 l/min, the blood pressure soon after weaning from cardiopulmonary bypass was low in patients who necessitated further circulatory assist, intraaortic balloon pumping (IABP) and/or additional surgical bypass procedure. In cases of CABG using arterial grafts and no vein graft, the perfusion pressure is most important to stabilize the hemodynamic status because low pressure may provoke peripheral vasoconstriction resulting in spastic reaction of the ITA and GEA. These arterial grafts seemed to keep the characteristics as the peripheral artery. Some papers pointed out less flow capacity of arterial grafts compared with that of saphenous vein graft, but CABG with arterial grafts alone was safe clinically if care is taken for keeping the perfusion pressure as high as preoperatively.

Adult↗
PubMed1993

[The long-term patency rate of saphenous vein grafts and vein graft disease in Japanese patients].

While annual attrition and high break-down rate of saphenous vein graft (SVG) used for CABG has widely noted in Western countries, no sizable studies have yet available in Japan. We studied 142 SVGs of 77 pts, which we divided into two groups; 80 SVGs of 44 pts in mid-term period (5 to 8 years after surgery) and 62 SVGs of 33 pts in long-term period (9 to 17 years after surgery). The patency rate of SVGs was 69% in mid-term and 77% in long-term. Whereas these patency rates at each periods were superior to those reported from USA and European countries, a quarter of SVGs in mid-term period and a half in long-term period had significant stenotic changes (over 50%). Of patent SVGs, diseased SVGs reached 36% in mid-term period and 73% in long-term period. In conclusion, although the patency rate of SVGs in Japanese patients was higher than that of the Western countries, vein graft disease apparently occurred in a large proportion of patent SVGs.

Aged↗
PubMed1993

[Two-staged repeat myocardial revascularization through the sternal re-entry and the left thoracotomy with coronary anastomosis under the beating heart].

A case report of serial repeat myocardial revascularization under the beating heart. A 56-year-old, hypertensive and hyperlipidemic male suffered from unstable angina who had undergone primary CABG with saphenous veins 10 years ago. The vein graft to the left anterior descending coronary artery (LAD) was solely patent but had a severely stenotic lesion. The stenotic LAD vein graft fed all coronary circulation. The second operation was approached through the sternal reentry but E-PTFE sheat for pericardial closure at the primary operation tightly adhered to an anterior aspect of the heart with abscess formation. So only gastroepiploic artery (GEA) could be anastomosed to the right coronary artery (RCA) under the beating heart without cardiopulmonary pump (CPB). While the postoperative angiogram showed GEA graft was patent, unstable angina recurred. Then the third operation was performed 2 weeks later through the left thoracotomy under the beating heart with CPB. A new saphenous vein was anastomosed from the descending aorta to LAD. He recovered well without any major complications. Postoperative angiogram showed two new grafts widely patent and he discharged with freedom from angina.

Angina, Unstable↗
PubMed1993

[Case report of MRSA sepsis required two valve replacement twice a year--trying case with hyperthermal extracorporeal circulation].

We report a case in conjunction with MRSA sepsis, who needed re-mitral valve replacement (re-MVR) and re-tricuspid valve imposition (re-TVI), and who was successfully treated with a number of antibiotics in conjunction with hyperthermal extracorporeal circulation. Initially, we performed MVR and tricuspid valve superimposition on a 62-year-old woman lationing under the MRSA sepsis condition to control against heart failure. However, she developed a fever following the first operation, and MRSA was detected from her blood cultivation. She thus underwent treatment employing many kinds of antibiotics. A thickened C.E. valve at the tricuspid valve cardiac echogram suggested PVE, we performed a second operation of re-MVR and re-TVI about a year after the first operation. We used a tangl of antibiotics during the operation, adding Vancomycin into the extracorporeal circulation, and utilized hyperthermal extracorporeal circulation. This patient's postoperative course was uneventful, with no recurrence arising at 23 months after the second operation.

Anti-Bacterial Agents↗
PubMed1992

Availability of the in situ right gastroepiploic artery for coronary artery bypass.

The right gastroepiploic artery (GEA) has been successfully used as a coronary bypass graft recently. We examined the in situ GEA graft length required from the pyloric portion to the site of coronary anastomosis at the time of operation. Measured GEA length was 17.0 +/- 1.7 cm for the posterior descending artery anastomosis in 17 patients, 17.8 +/- 1.7 cm for the main right coronary artery anastomosis in 13 patients, 22.0 +/- 2.3 cm for the posterolateral branch anastomosis in 7 patients, and 21.0 cm for the left anterior descending artery anastomosis in 1 patient. We examined 228 randomly selected abdominal angiograms and measured the internal diameter of the right GEA at every 2-cm interval from its origin. Probability of availability of the in situ GEA graft for each site of anastomosis was 97% to the right coronary artery and 88% to the anterior descending or the circumflex artery when the internal diameter of GEA was 1.5 mm or greater. From an anatomical standpoint, we concluded that the GEA can be assumed available without preoperative angiography.

Adult↗
PubMed1992

[Percutaneous transluminal coronary angioplasty and coronary bypass grafting for refractory angina in chronic dialysis patients].

Between June 1983 and July 1989, 25 consecutive chronic dialysis patients with medically refractory angina pectoris underwent revascularization, either percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG) (21 males and 4 females, mean age of 57 +/- 10 years, and mean duration of dialysis of 3.7 +/- 5.0 years). Patients with single-vessel disease and/or mildly calcified lesions received PTCA (n = 15), while those with multi-vessel disease and/or severely calcified lesions received CABG (n = 10). As controls for PTCA-treated dialysis patients, 208 non-dialysis patients who received initial PTCA in 1988 were used. The mean number of diseased vessels was 2.7 +/- 0.7 for CABG group, and 1.5 +/- 0.8 for PTCA group (p < 0.01). In both groups, 80% of patients were successfully revascularized. In CABG group, however, 7 of 10 patients had major complications including 2 hospital deaths, while no complications occurred in the PTCA group. During the follow-up period after CABG (35 +/- 30 months), recurrent angina developed in one patient, who was successfully treated with PTCA. In the PTCA group, angiographic success was initially obtained in 16 of 21 lesions (76%), which was significantly lower than that in the control group (92%, p < 0.05). Follow-up angiography revealed restenosis in 6 of 16 lesions with successful PTCA (38%), similar to that observed in the control group (32%, p = ns). A second PTCA was successful in 5 of 6 patients with restenosis, however, 4/5 patients developed recurrent angina. Three of 4 patients with a second episode of restenosis underwent a third PTCA, and angina recurred in 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[The calcified ascending aorta--preoperative evaluation and intraoperative management].

Aortic calcification was evaluated preoperatively by computed tomography (CT) in 136 of 275 candidates for coronary artery bypass surgery (age range, 30-80) years (mean 60.2 years), including 110 men and 26 women), from April 1989 to March 1991. Calcification in the mid-ascending aortic wall was detected in 20 (14.7%) cases, calcification in all regions of the aorta was more common in patients older than 60 years (22.5%, n = 71), than younger (6.2%, n = 65) (p less than 0.01). Atherosclerosis of the ascending aorta was identified intraoperatively in 25 (18.3%) cases. Practically, the specificity of CT findings was excellent (98.3%), but the sensitivity was less satisfactory (72.0%) due to the presence of atherosclerosis without calcification. In cases of arteriosclerosis of the ascending aorta, great care was taken to prevent embolism secondary to a dislodged atheromatous plaque. The "aortic no-touch technique", with in situ internal thoracic artery and right gastroepiploic artery anastomosis under ventricular fibrillation, was performed in 6 cases, a single aortic cross-clamp was applied in 19 cases, and conventional methods were employed when the ascending aorta was normal or the "no-touch" or "single-clamp" procedure could not be used (control, 111 cases). No neurologic complications occurred in the "no-touch" group, while 2 cerebral infarctions occurred in the single-clamp group (10.5%) and the control group (1.8%) respectively. These differences between groups was not significant. Patients with a calcified ascending aorta are at higher risk for neurologic complications of coronary bypass. The risk can be decreased by minimizing surgical trauma to the ascending aorta by the use of "no-touch" techniques.

Adult↗
PubMed1992

Physiological and pharmacological responses of arterial graft flow after coronary artery bypass grafting measured with an implantable ultrasonic Doppler miniprobe.

BACKGROUND: The present study was designed to investigate physiological and pharmacological responses of the arterial graft flow measured by the directly implanted ultrasonic pulsed Doppler miniprobe after coronary artery bypass grafting (CABG). METHODS AND RESULTS: Our original 5-MHz, 5-mm-diameter, Doppler mini-flow probe catheter, which has four silicone brims in front to facilitate its fixation onto the graft without direct suture, was attached onto internal thoracic artery (ITA) and gastroepiploic artery (GEA) grafts during CABG in 10 patients. Approximately 2 weeks postoperatively, when the patient's condition was quite stable without medication, changes of flow velocity in those grafts induced by catecholamine, exercise, taking meals, and coronary vasodilating drugs were measured. Dobutamine significantly increased both ITA and GEA graft flow velocity (p < 0.01), whereas dopamine had no distinct positive effect. Upon the patient taking meals, the GEA graft showed an 83% increase of the flow velocity (p < 0.05), whereas the ITA graft showed no significant change. Walking exercise for 6 minutes increased both grafts' flow velocity up to two times that of control values (p < 0.01). Oral intake of coronary vasodilating drugs showed no significant effect. After the investigation was completed, the probe was removed easily at bedside without difficulty. CONCLUSIONS: Using this implantable Doppler miniprobe, postoperative function in the individual coronary bypass graft under various conditions was effectively investigated.

Blood Flow Velocity↗
PubMed1992

[Coronary artery bypass grafting by utilizing the artery grafts and bovine internal thoracic artery graft (Bioflow in an elderly patient)].

We performed coronary artery bypass grafting (CABG) in a 80-year-old male with calcified ascending aorta and severe varicose veins utilizing the bilateral internal thoracic arteries and the right gastroepiploic artery under fibrillatory arrest without aortic cross-clamp (aortic no-touch technique). After triple coronary artery bypass grafting was completed, heart failure occurred. Additional Bioflow graft to the circumflex artery restored good cardiac function. The aortic no-touch technique is a useful method for CABG in patients with severe calcified ascending aorta. This experience suggests that the Bioflow graft is a helpful conduit at an urgent situation in CABG.

Aged↗