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Biomedical subjects

H Suma

Publications and source records attributed to H Suma.

At least 19 recordsLinked to original sources
PubMed1998

Use of the Harmonic Scalpel for harvesting arterial conduits in coronary artery bypass.

A simple and effective technique is described here for harvesting the gastroepiploic artery (GEA) and radial artery (RA) using the Harmonic Scalpel. The mean time of harvesting GEA was 9 min and that of RA was 17 min. There were no injuries or spasms of those grafts and the postoperative angiograms performed in 28 patients. This shows 100% patency of the conduits. The GEA and RA are safely harvested by using the Harmonic Scalpel and the use of arterial conduits in coronary artery bypass grafting (CABG) seems to be easily achieved.

Aged↗
PubMed1998

[Early result of volume reduction left ventriculoplasty (Batista operation) for dilated cardiomyopathy].

The Batista operation is intended to improve cardiac function by reducing the diameter of the left ventricle by excising of a sizable amount of the left ventricular free wall. Candidates for this operation are patients awaiting cardiac transplantation due to end-stage dilated cardiomyopathy and those unsuitable for transplantation because of age, physical or economical reasons. We performed this operation in 10 patients between December 1996 and October 1997. The baseline indication is left ventricular diastolic dimension > or = 70 mm and New York Heart Association (NYHA) class III or IV. There were eight men and two women aged from 16 to 60 years (mean 46 years). All had non-ischemic cardiomyopathy including seven idiopathic and one each of hypertrophic, arrhythmogenic right ventricular and valvular (sarcoidosis) cardiomyopathy. Eight patients were in NYHA class IV and six needed inotropic drip therapy prior to the operation. Nine patients had significant mitral regurgitation and six had tricuspid insufficiency concomitantly. Eight patients underwent mitral valve replacement and one was treated with mitral valve plasty. Six patients also had tricuspid plasty combined with partial left ventriculectomy. Eight patients survived. Mean value of left ventricular end-diastolic diameter was reduced from 77.8 mm to 59.8 mm, left ventricular end-diastolic volume index was reduced from 189.3 to 99.2 ml/m2, ejection fraction was increased from 19.0% to 33.8% and NYHA class improved from 3.8 to 1.8. Six months later, left ventricular dilatation was not noticed in four patients examined. The Batista operation offers real hope for patients with end-stage dilated cardiomyopathy, but we still have much to learn.

Adolescent↗
PubMed1998

[Dor operation for end-stage ischemic cardiomyopathy].

Endoventricular circular patch plasty (Dor operation) was used to treat end-stage dilated ischemic cardiomyopathy in 13 patients from January to December, 1997. There were 10 men and three women aged from 57 to 78 years (mean 63 years). Single, double, triple and left main trunk coronary disease was present in one, two, eight and two patients, respectively. Mean ejection fraction was 22% (6-30%) and signs of congestive heart failure were clear in all patients [New York Heart Association (NYHA) class III in eight patients and class IV in five patients]. Angina pectoris was present in five patients. Six patients had associated significant mitral regurgitation. Coronary artery bypass grafting (mean 3.2 grafts) was used in 11 patients and mitral valve reconstruction was performed in 6 patients (4: replacement and 2: repair) combined with akinetic area exclusion by the Dor technique. All patients were successfully weaned from cardiopulmonary bypass without mechanical support and no perioperative death occurred. Three patients died in hospital at 1-2 postoperative months due to pneumonia, stroke and heart failure, respectively. Two patients died during the late period due to stroke and sudden death. Among the eight survivors, six patients were in NYHA class I-II and two patients in class III. Ejection fraction increased from 22% to 36%, end-diastolic and systolic volume indices decreased from 168 +/- 58 to 123 +/- 39 ml/m2 and from 131 +/- 60 to 81 +/- 33 ml/m2, respectively. Pulmonary capillary wedge pressure decreased from 19 +/- 10 to 14 +/- 5 mmHg. The Dor procedure is an effective surgical alternative for patients with end-stage ischemic cardiomyopathy who are considered to be candidates for cardiac transplantation.

Aged↗
PubMed1997

Semiskeletonization of internal thoracic artery: alternative harvest technique.

A simple technique of harvesting the internal thoracic artery is described. Harvesting the internal thoracic artery as a thin pedicle without the endothoracic fascia is advantageous in terms of obtaining its maximum length, dissecting a narrow space, avoiding pleural opening, and facilitating handling of the internal thoracic artery during the coronary anastomoses. This alternative-technique requires almost the same skill and time as the conventional wide pedicle technique.

Humans↗
PubMed1997

[New surgical procedure for patients with dilated heart and end-stage cardiac failure (Batista procedure)].

A 53-year-old man with dilated cardiomyopathy underwent left ventriculoplasty (Batista procedure), a new surgical procedure, which reduces ventricular volume to improve left ventricular function. Left ventricular ejection fraction increased from 19.7% to 43.7%. Unfortunately, he died of pneumonia 12 days after surgery. This is the first such procedure in a human in Japan.

Cardiac Surgical Procedures↗
PubMed1997

Left ventriculoplasty: a new option for end-stage cardiomyopathy.

To treat end-stage dilated cardiomyopathy, we have performed volume reduction left ventriculoplasty (as introduced by Randas Batista in Brazil) in four patients since December 1996. All patients had end-stage idiopathic cardiomyopathy. Mitral valve replacement was also performed in three patients. In all four patients, improvement of left ventricular function was noted. One patient died of respiratory failure on the 12th postoperative day. The other three patients recovered successfully from the operation (i.e., they were discharged from hospital with the functional status in New York Heart Association Class I or II). We conclude that the Batista operation provides a real hope for patients with end-stage dilated cardiomyopathy.

Adult↗
PubMed1996

Thrombotic occlusion of the coronary artery associated with accidental detachment of undeployed Palmaz-Schatz stent.

We describe a case of coronary stenting in which accidental detachment of the Palmaz-Schatz stent induced thrombotic occlusion of the coronary artery. This case suggests that careful consideration of the risk involving coronary occlusion is mandatory on deciding the therapeutic strategy of the cases in which the unexpanded coronary stent cannot be retrieved following successful deployment.

Adult↗
PubMed1996

Use of the radial artery for myocardial revascularization.

BACKGROUND: The radial artery was first used as a coronary graft by Carpentier and associates in 1973 but, due to the disappointing results, it was abandoned. In 1992 its revival coincided with the widespread use of calcium-channel blockers in cardiovascular surgery, in the belief they could prevent spasm. METHODS: From January 1993 to October 1995 we operated on 109 patients for myocardial revascularization employing the radial artery with two different surgical techniques: in 95 patients (group 1) it was "pretreated" by opening its fascia after a gentle hydrostatic dilation and then anastomosed to the aorta; in 14 patients (group 2) it was branched to another conduit. We had two operative deaths (1.82%). RESULTS: At a mean interval of 532.42 days 105 patients are still alive, 2 (1.86%) having died of abdominal tumors. Fifty-six patients (52.33%) underwent angiography at a mean interval of 334.42 days: the patency of the radial artery was 88.88% in group 1 and 62.50% in group 2. Indications and contraindications are discussed. CONCLUSIONS: The radial artery is an easily manageable conduit whose early patency is very promising, although a longer follow-up is mandatory.

Adult↗
PubMed1996

Innominate and subclavian arteries as an inflow of free arterial graft.

To find a suitable inflow site for free arterial grafts in myocardial revascularization, I used the innominate artery for the radial artery graft in 4 patients and the left subclavian artery for three radial grafts and one free gastroepiploic artery graft. All 8 patients were alive, and all five restudied grafts were all patent. The innominate and subclavian arteries are suitable in terms of better wall matching and avoidable aortic clamping in cases of atherosclerotic ascending aorta.

Adult↗
PubMed1996

Effects of competitive blood flow on arterial graft patency and diameter. Medium-term postoperative follow-up.

To identify predictors of arterial graft patency, we followed up 30 internal thoracic arterial grafts and 23 right gastroepiploic arterial grafts in situ with patency documented during postoperative angiography. After 24 months of follow-up on average, repeat angiography detected that one internal thoracic artery and two gastroepiploic arteries were anatomically occluded and that the other three gastroepiploic arteries were nonfunctioning. The logistic regression model identified a relationship between graft patency and competitive flow, which was detected as stenosis in the recipient coronary arteries (coefficients, p < 0.05; model, Hosmer-Lemeshow chi2 statistic 3.59, p = 0.89). The linear regression model demonstrated that changes in graft luminal diameter correlated with competitive flow (p < 0.01), smoking history (p < 0.05), and type of arterial grafts (p < 0.001) (R2 = 0.40, adjusted R2 = 0.36). The findings suggest a temporal relationship between competitive flow and prognosis of arterial graft.

Abdominal Muscles↗
PubMed1996

Gastroepiploic artery graft in 400 patients.

The right gastroepoploic artery (GEA) has been used for coronary artery bypass grafting (CABG) in 400 patients of a total of 1359 undergoing the same procedure during an 8-year period. There were 327 males and 73 females with a mean age of 59 years. Single-, double- and triple-vessel and left main disease were noted in 4, 51, 283 and 62 patients, respectively. Previous myocardial infarction was noted in 208 patients and 40 patients had undergone previous CABG. Internal thoracic artery (ITA) and inferior epigastric artery grafts were concomitantly used in 388 (97%) and 30 (8%) patients, respectively. The mean number of grafts was 3.2 including vein grafts, and 2.3 coronary arteries were bypassed with arterial grafts. The sites of GEA grafting were 43 anterior descending, 6 diagonal, 71 circumflex, and 287 right coronary arteries with 376 in situ and 24 free grafts including 7 sequential grafts. There were eight (2%) early and five (1.3%) late deaths. New Q waves were noted in six (1.5%) patients. Warm body circulation is thought to be favorable with a lower incidence of the need for intra-aortic balloon pump (0.6% vs 6.0%). Postoperative angiography revealed 94% (253/268) early (2 months) and 94% (47/50) late (2-5 years) patency of GEA grafts. In conclusion. GEA is a safe and effective arterial conduit for CABG.

Abdominal Muscles↗
PubMed1996

Prolonged luminal narrowing of internal mammary artery graft after percutaneous transluminal angioplasty.

The authors describe a case with an internal mammary artery (IMA) graft that demonstrated prolonged, but reversible, luminal narrowing persisting > twenty-four hours following percutaneous transluminal angioplasty. Luminal narrowing disappeared spontaneously, however, at the time of follow-up angiography one week after the angioplasty. Since haziness at the dilation site had been shown on preprocedural angiogram, suggestive of intraluminal thrombus, this phenomenon may be attributed to either prolonged vasospasm or distal embolization of the IMA graft.

Angioplasty, Balloon, Coronary↗
PubMed1996

Long-term outcome of percutaneous transluminal coronary angioplasty and coronary bypass surgery for multivessel coronary artery disease.

We studied the short- and long-term outcomes of 97 patients treated with percutaneous transluminal coronary angioplasty (PTCA) and 72 patients treated with coronary artery bypass graft surgery (CABG) for multivessel coronary artery disease in a single hospital in 1989. Patients treated with CABG had a higher angina class, a higher incidence of diabetes mellitus and a greater extent of the disease. Complete revascularization was achieved in 61 patients (85%) with CABG and in 45 patients (46%) with PTCA (p < 0.001). Initial success of PTCA and CABG was obtained in 95% and 94% of the patients with PTCA and CABG, respectively. Actuarial survival rates at 5 years were similar (96% in the PTCA group; 94% in the CABG group). Fewer patients suffered from cardiac death or myocardial infarction in the CABG group than in the PTCA group, but this difference was not significant. The rate of survival free from death, myocardial infarction, CABG and repeat PTCA, was significantly higher in the CABG group than in the PTCA group (85% vs 48%; p < 0.001). These results suggest that CABG provides a favorable long-term outcome in patients with multivessel coronary artery disease and that PTCA provides a similar outcome in these patients when applied to suitable lesions, although more patients who undergo PTCA require repeat procedures.

Aged↗
PubMed1996

[Multivessel coronary artery bypass grafting with arterial conduits].

With increased use of catheter intervention, candidates for coronary artery bypass grafting (CABG) have become more severely diseased. In the past 4 years with normothermic cardiopulmonary bypass technique, operative mortality was 1.5% (0.7% for elective and 5.6% for emergency) in 690 primary CABGs. The internal thoracic artery graft was used in 94% of the patients and the patency rate was 98%. The gastroepiploic artery was used in 565 patients since 1986 with 2.3% operative mortality and the patency rate was 96% in early and 92% in mid-term angiography. The inferior epigastric artery was used in 48 patients with 2% operative mortality and 90% patency rate. The radial artery was used in 105 patients with 0.9% operative mortality and patency rate was 88% at 1 postoperative year. Surgical result and angiographic patency of the graft are acceptably good while candidates of CABG have become more severely diseased. With use of arterial conduits, better long term outcome can be expected.

Adult↗
PubMed1996

Optimal use of the gastroepiploic artery.

In 10 years' experience with the right gastroepiploic artery graft for myocardial revascularization, excellent clinical and angiographic mid-term results have been reported. From our experience in 518 patients who underwent CABG with a gastroepiploic artery graft since 1986, early and late mortality rates were 2.3% and 1.0%, respectively. Early and mid-term (2 to 5 years) angiographic patency rates were 96% and 92%, respectively, in the in situ gastroepiploic artery grafts. The gastroepiploic artery is the second best arterial conduit next to the internal thoracic artery at present, and is most useful at reoperation or for patients with atherosclerotic ascending aorta. With proper basic knowledge and surgical technique, the gastroepiploic artery can be used without increasing surgical mortality and morbidity, and good long-term patency can be expected.

Adolescent↗
PubMed1996

[A case of familial cardiac myxoma].

We experienced a case of familial cardiac myxoma observed in a mother and her daughter. A 58-year-old woman was addmited to our hospital because of repeated cerebral embolism. Echocardiography showed a left atrial myxoma to be considered as the cause of cerebral embolism. At the operation, 3 myxomas were found in the left atrium, and were removed successfully. No recurrence has been observed for 14 years after the operation. Three years after that, her 3rd child, 31-year-old-women, suffered from cerebral embolism and was also diagnosed as a left atrial myxoma. A friable myxoma was removed with the interatrial septum. She had no recurrence for 11 years after the operation. In patients with cardiac myxoma who have unusual biologic behavior, including familial myxoma, "complex" type myxoma must be suspected. We suggest that it is important to distinguish patients with "complex" type myxoma, because the recurrence rate is much higher in those than in patients with "sporadic" type myxoma.

Adult↗
PubMed1996

Radial artery from left subclavian artery in redo coronary artery bypass grafting.

In redo coronary artery bypass grafting a left anterior thoracotomy can be used, if necessary, to avoid a dangerous repeat median sternotomy. In 2 patients with a well-functioning left internal mammary artery graft to a left anterior descending artery attached to the sternum, a radial artery was used with the left subclavian artery as the blood source. This technique can be used successfully in selected cases when a left thoracotomy is advisable and an arterial graft is preferred to a saphenous vein.

Anastomosis, Surgical↗