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Biomedical subjects

H Bolooki

Publications and source records attributed to H Bolooki.

At least 19 recordsLinked to original sources
PubMed1993

Sequential internal mammary artery grafts for coronary artery bypass.

From 1985 to 1990, 145 patients underwent isolated coronary artery bypass with one (n = 128) or both (n = 17) internal mammary arteries (IMAs) used as sequential bypass grafts. All but 2 patients had angina pectoris preoperatively. A total of 162 sequential IMA grafts were constructed bypassing two (n = 152) or three (n = 10) coronary artery sites as in situ (n = 132) or free (n = 30) grafts. In 12 patients, one IMA was used as a nonsequential graft. Thirty-day mortality was 2.8% (n = 4 patients). Perioperative myocardial infarction occurred in 1 patient (0.7%). Only two sequential IMA grafts failed. Both were used to bypass coronary arteries 1.00 mm in diameter. Mean follow-up was 31 months (range, 6 months to 4.2 years). There were three late deaths. Of 136 survivors followed-up, 121 (89%) were free of angina. Postoperative rotational thallium 201 tomography was done in 73 patients. Myocardial ischemia was detected in 11 diabetic patients (15.1%), but corresponded to a sequential IMA graft in 4 (5.5%) and to nonsequential and venous grafts in 10 patients (13.7%). Coronary revascularization with sequential IMA grafts was safe and effective.

Adult↗
PubMed1992

Late complications of plombage.

Plombage was used commonly in the management of tuberculosis before the early 1950s. From 1977 through 1990, 4 patients were seen with complications of plombage performed decades previously. Lucite spheres were used in 3 patients and paraffin in 1. One patient had bilateral apical plombage. In all cases, complications were related to infection or migration of the foreign material. Two patients had extrusion of foreign material or fluid into the chest wall. One patient had hemoptysis and infection due to erosion of a Lucite sphere into the lung. Another had intestinal obstruction subsequent to erosion into the esophagus. The patient with bilateral plombage had development of asynchronous complications on both sides. Treatment consisted of removal of the foreign material and individualized management of the remaining space. There were no operative deaths and the outcome was good in all cases.

Aged↗
PubMed1992

Long-term surgical results in sudden death syndrome associated with cardiac dysfunction after myocardial infarction.

To evaluate the surgical results in patients with inducible ventricular tachyarrhythmias due to coronary disease and left ventricular dysfunction, the authors reviewed their experience in 170 patients who had survived one or more cardiac arrests after myocardial infarction and were unresponsive to drug therapy based on electrophysiologic studies (EPS). There were nine operative deaths (5%). Based on intraoperative EPS, surgical remodeling of left ventricular dysfunction (aneurysm resection, infarct debulking, and septal reinforcement) with map-guided cryoablation and coronary artery bypass graft was performed in 34 patients (group A), and left ventricular remodeling and coronary artery bypass graft without guided endocardial resection was performed in 25 patients (group B). Forty-three patients (group C) had coronary artery bypass graft with implantation of an automatic implantable cardioverter defibrillator (AICD). Group D (68 patients) received AICD only. After operation, based on EPS results, four patients in group A (12%) and three patients in Group B (15%) required AICD implantation. Overall survival at 6 years was 65%, 48%, 85%, and 58% in patient groups A, B, C, and D, respectively (p = not significant). During follow-up in group A patients, none died suddenly and none needed AICD. In group B, two patients required AICD 3 and 5 years later, and five patients died suddenly. The incidence of sudden death was 2.3%/patient/year and 3.5%/patient/year after AICD implantation (groups C and D). At 6 years, cardiac-event-free survival was 80% and 70% for groups A and B and 38% and 24% for groups C and D, respectively (p less than 0.001). Patients receiving map-guided ablative procedures had significantly improved cardiac-event-free survival rates.

Adult↗
PubMed1990

Surgical treatment of complications of acute myocardial infarction.

Complications of acute myocardial infarction that develop within the first 2 weeks after its onset have been associated with a poor prognosis and dismal surgical outcome. In recent years, aggressive use of hemodynamic monitoring and interventions that improve myocardial oxygen supply and demand have noticeably altered the prognosis. Urgent relief of myocardial ischemia with coronary reperfusion has had the largest impact in improving the results. Surgical treatment of mechanical and nonmechanical complications of acute myocardial infarction requires prompt decision making and expeditious implementation. Persistent left ventricular dysfunction and cardiogenic shock are the most important factors that influence the overall results.

Angioplasty, Balloon, Coronary↗
PubMed1990

Atrialization of right ventricular pressure during acute cardiac allograft rejection.

We describe a patient who, during an episode of acute cardiac rejection, developed such severe systolic dysfunction that there was transient near-adynamic function of the right ventricle. This right ventricular dysfunction was reflected hemodynamically by the unusual finding of atrialization of right ventricular pressures. The patient's cardiac function returned to normal after treatment with extensive immunotherapy.

Acute Disease↗
PubMed1989

Emergency cardiac procedures in patients in cardiogenic shock due to complications of coronary artery disease.

Onset of cardiogenic shock in patients with various manifestations of acute myocardial ischemia has high mortality, but use of improved hemodynamic monitoring, the intra-aortic balloon pump, and early operation have improved previously dismal results. Review of published experience spanning the last 20 years indicates that 66% of patients survive after emergency myocardial revascularization for acute myocardial infarction and cardiogenic shock. If cardiac damage is overwhelming and irreversible, selected patients may be "bridged" with mechanical biventricular circulatory assist devices and transplanted. Infarctectomy for acute myocardial infarction remains controversial and unproven; successful repair of free left ventricular wall rupture is uncommon. In patients with cardiogenic shock, operations for acute postinfarction ventricular septal defect or mitral insufficiency have operative survival rates of 45% and 54%, respectively. Long-term (greater than 2-year) survival for patients after repair of acute postinfarction ventricular septal defect is 84%. However, 5-year survival after successful operation for acute postinfarction mitral insufficiency complicated by cardiogenic shock is only 40%.

Actuarial Analysis↗
PubMed1988

Hemodynamic effects of radical left ventricular scar resection in patients with and without congestive heart failure.

To evaluate the hemodynamic changes that occur following radical left ventricular scar resection we studied 40 patients (mean age, 59.2 years; 36 males) with complete hemodynamic evaluation preoperatively (preop) and 5 to 12 days postoperatively (postop). Severe congestive heart failure (CHF) was present in 15 patients, ventricular arrhythmias in 19, and angina in 19 patients preop. The operation consisted of extensive scar resection with complete myocardial revascularization (average 2.4 grafts per patient). Ten patients required intraaortic balloon pump assist for up to 8 days postop. Postoperative left ventricular ejection fraction (EF) was estimated with multiple gated acquisition scanning. A significant rise in heart rate was observed in the whole group of patients postop (P = 0.000). In the group of patients with CHF preop the EF was increased from 25.1 +/- 8.4% (mean +/- SD) preop to 30.9 +/- 11.2% postop (P = 0.003), the cardiac index was increased from 2.2 +/- 0.5 liters/min/m2 preop to 2.7 +/- 0.5 liters/min/m2 postop (P = 0.02), and the pulmonary artery wedge pressure was decreased from 22.0 +/- 7.7 mm Hg preop to 15.5 +/- 4.3 mm Hg postop (P = 0.005). In the patients without active CHF preop no improvement in the above hemodynamics was noted. In conclusion, radical left ventricular scar resection significantly increased EF and CI and decreased PAW in patients with preop CHF, whereas in the absence of CHF this procedure resulted in minimal hemodynamic changes.

Adult↗
PubMed1986

Automatic implantable cardioverter-defibrillator: techniques of implantation and results.

An initial experience with use of the automatic implantable cardioverter-defibrillator (AICD) is described. Twelve patients received the device. One death has occurred during a mean follow-up of 15 months, and it was due to causes other than arrhythmias. Appropriate device discharge terminating a malignant arrhythmia occurred in 9 patients (75%). The observed survival (92%) far exceeds that to be expected in survivors of sudden death treated by conventional means. There have been no operative deaths. Morbidity has been minimal, although three reoperations were required in 2 patients because of lead dislodgment. The AICD has been demonstrated to be effective in treating patients at risk for sudden arrhythmic death. It can be employed safely with minimum morbidity using a variety of implantation techniques.

Aged↗
PubMed1986

Comparison of long-term results of Carpentier-Edwards and Hancock bioprosthetic valves.

The long-term survival following valve replacement with Carpentier-Edwards or Hancock bioprostheses was compared between the two valve models and between the two groups totaling 407 patients who were discharged after valve replacement beginning in 1974. The two groups of patients were treated in a nonrandomized fashion. The actuarial survival for 299 patients with Carpentier-Edwards valves was 94 +/- 1.5% (+/- standard error) and 93 +/- 1.7% after 5 and 8 years of follow-up, respectively. Comparable figures for 108 patients undergoing valve replacement with Hancock valves were 89 +/- 3.0% and 83 +/- 3.7%, respectively (p = not significant [NS]). The probability of freedom from death and valve removal after 5 and 8 years of follow-up was 91 +/- 1.8% and 79 +/- 4.6%, respectively, with the Carpentier-Edwards valve and 84 +/- 3.5% and 75 +/- 4.3%, respectively, with the Hancock valve (p = NS). An accelerated rate of attrition for both valves was observed in the mitral position. There were no significant differences in actuarial survival between the two valves in the mitral or the aortic position or in the incidence of major valve-related complications.

Adolescent↗
PubMed1986

Surgical management of post-myocardial infarction ventricular tachyarrhythmia by myocardial debulking, septal isolation, and myocardial revascularization.

Sustained ventricular tachycardia or ventricular fibrillation, associated with severely depressed left ventricular function after myocardial infarction, carries a poor prognosis. We have used an extensive surgical procedure in 18 patients (15 men and three women) with a mean age of 63 years who had more than three episodes of recurrent, hemodynamically significant ventricular tachycardia or fibrillation and congestive heart failure. The operation consisted of complete myocardial revascularization and myocardial debulking by extensive infarctectomy with unguided endocardial resection and septal isolation with support of the necrotic wall with a Teflon patch. Implantable defibrillator patches were placed in eight patients. Blood cardioplegia and intra-aortic balloon assist (12 patients) were used for perioperative myocardial preservation. Postoperative studies demonstrated a significant increase in ejection fraction (n = 16) and a decline in pulmonary wedge pressure. Hospital mortality was 16% (three patients). Two deaths were due to congestive heart failure and one to arrhythmia. During postoperative electrophysiologic studies, ventricular tachycardia was not inducible in six of eight patients (75%). During a mean follow-up of 24 months, 11 of 15 patients who survived operation are alive and are in New York Heart Association Class I or II. Three of four late deaths were due to congestive heart failure and drug toxicity and one was arrhythmia related. This procedure is effective for preventing recurrent ventricular tachycardia or fibrillation in a majority of patients who cannot have intraoperative mapping.

Aged↗
PubMed1985

Current status of circulatory support with an intra-aortic balloon pump.

Although the initial clinical application of IABP was for the purpose of support of circulation in cardiogenic shock, its indications have expanded and include prophylactic use, especially in patients with ischemic heart disease. Controversy exists regarding the efficacy of this device in these conditions. Prolonged balloon support for periods of more than 5 days is presently employed in patients with chronic heart failure undergoing cardiac surgery, without concern for so-called "balloon dependence." In recent years, the incidence of use of IABP has declined markedly mainly because of comparable effects obtained by hemodynamic treatment with various drugs aimed at altering a specific parameter of cardiac function. Percutaneous application of a intra-aortic balloon catheter, although associated with a higher complication rate, has brought to clinical practice a rapid method for utilization of this device under fluoroscopic control. Because of an appreciable number of complications, however, balloon assist should be used for very specific clinical conditions.

Adult↗
PubMed1983

Failure of Hancock xenograft valve: importance of valve position (4- to 9-year follow-up).

To evaluate long-term durability of Hancock valves, we reviewed our results in 107 hospital survivors (120 valves) who were operated on during 1974 through mid-1979. Mitral valve replacement was done in 63 patients, aortic valve replacement in 20, and mitral valve replacement combined with other procedures in 24. The 7-year survival was 84 +/- 4% (standard error of the mean) for 91 patients and 97 valves. During a follow-up of 590 patient-years, 15 (12 mitral and 3 aortic) of 120 valves at risk (87 mitral, 32 aortic, 1 tricuspid) were removed from 14 patients. Six valves (3 mitral and 3 aortic) were removed because of bacterial endocarditis. One mitral valve was removed because of thromboembolism. Eight mitral valves were removed because of valve structural failure, which occurred at a mean follow-up of 42 months. These valves showed extensive calcification, leaflet perforation, or cusp tear. Structural failure was unrelated to valve size, year of implantation, or valve shelf-life. Structural failure was not seen after aortic valve replacement. Results show that structural failure of the Hancock xenograft valve in the mitral position is related primarily to valve position. After aortic valve replacement, valve failure is predominantly due to endocarditis. Although medium-term (mean, 6-year) durability of this xenograft valve compares satisfactorily with prosthetic valves, its high failure rate in the mitral position indicates the necessity for improvement in valve mounting, design, and preservation.

Adolescent↗
PubMed1982

Surgery of descending aorta. A method of autotransfusion and intercostal artery preservation.

Paraplegia is a tragic complication of surgery of the descending aorta. It is unpredictable and occurs with a similar incidence with or without distal circulatory support. Hypotension, prolonged aortic cross clamp time, and ligation of intercostal arteries have been considered causative factors. Recent experience with ten consecutive patients undergoing descending aortic surgery without shunts employed a method of autotransfusion and intercostal preservation. There were no deaths, renal failure, or paraplegia. The perioperative blood requirement per patient was 2.4 units of blood.

Adult↗