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Biomedical subjects

M A Sarsam

Publications and source records attributed to M A Sarsam.

15 recordsLinked to original sources
PubMed1998

Repair of descending thoracic aortic dissection or aneurysm combined with repair of the proximal aorta via median sternotomy.

A single-stage procedure for repair of the whole thoracic aorta via median sternotomy is described. The procedure is based on exposure of the descending aorta, posterior to the pericardium in the oblique sinus, or exposure of the aorta in the supracoeliac region and the placement of an endoprosthesis as an intraluminal graft. The ascending aorta and arch repair can be carried out as usual. The procedure has been performed in five patients with either dissection or aneurysm in the period between 1992 and 1997.

Aged↗
PubMed1995

Orthotopic cardiac transplantation: a comparison of standard and bicaval Wythenshawe techniques.

We describe an alternative technique for orthotopic cardiac transplantation (bicaval Wythenshawe technique), which maintains the right and left atrial anatomy. We compared the new bicaval technique with the conventional (Lower and Shumway) technique of orthotopic cardiac transplantation to identify any beneficial physiologic and clinical outcomes resulting from maintaining the normal anatomy. Seventy-five patients were randomized on an alternate basis to two groups: group A (n = 40) had orthotopic cardiac transplantation with the bicaval technique and group B (n = 35) had conventional orthotopic heart transplantation. All patients were studied with transthoracic echocardiogram, endomyocardial biopsies, and measurement of intracardiac pressures 1, 4, and 12 weeks after transplantation. There were no statistically significant differences in the demographic profile, ischemic time, bypass time, implantation time, transpulmonary gradient, or pulmonary vascular resistance between the two groups. The hemodynamic data were collected in the absence of histologic signs of rejection. In group A right atrial pressure (mean 3.6 mm Hg) was significantly lower (p < 0.03) than in group B (mean 8.8 mm Hg). The right atrial a wave was recorded in 38 patients in group A compared with seven patients in group B (p = 0.041). Atrial tachyarrhythmias occurred in two patients in group A compared with 11 in group B (p < 0.016). Temporary pacing was required in 10 patients in group A and 16 patients in group B (p = 0.034). Four cases of mitral regurgitation (all mild) were detected in group A in comparison with 12 cases (10 mild, 2 severe) in group B (p = 0.008). The mean ejection fraction in the first week after transplantation was 58% in group A and 46% in group B (p = 0.5). In the first 3 months the need for diuretics was less in group A (mean dose 80.8 mg furosemide daily) than in group B (mean dose 134 mg furosemide daily in the first week increasing to 160 mg furosemide daily). Hospital stay was shorter in group A (mean 23 days) than in group B (mean 27 days) (p < 0.015). There were no early deaths as a result of right ventricular failure in group A (n = 0/40) compared with four (n = 4/35; 9%) in group B (p < 0.034). This difference suggests that bicaval orthotopic cardiac implantation is associated with a lower right atrial pressure, a lower likelihood of atrial tachyarrhythmias, less need for pacing, less mitral incompetence, a lower diuretic dose, and a shorter hospital stay.(ABSTRACT TRUNCATED AT 400 WORDS)

Echocardiography↗
PubMed1995

A simplified technique for repair of an injured internal mammary artery.

Injury to the internal mammary artery (IMA) during harvesting or the construction of sequential anastomosis can be troublesome and may force the surgeon to abandon the use of this valuable conduit. Since July 1991, we have utilized a simple technique for repair of a damaged IMA anywhere along its length. This involves leaving the IMA as a pedicled in situ graft and anastomosing a small piece of vein graft to an arteriotomy at the site of injury. The IMA is then used as originally planned, usually to the left anterior descending, and the vein graft can be used for a second vessel or simply tied. The technique was used in 12 patients, all of whom had an uncomplicated postoperative course.

Humans↗
PubMed1994

Postpneumonectomy chylothorax.

Over a period of 22 years, chylothorax developed in 9 of 1,800 patients who underwent pneumonectomy. Two groups were identified. In group I (n = 5), accelerated opacification of the pneumonectomy space was noted, but the mediastinum remained shifted to the pneumonectomy site. No hemodynamic problems developed and their course was no different from that of other patients who had undergone pneumonectomy. In the second group (group II; n = 4), rapid opacification of the pneumonectomy space was accompanied by mediastinal shift away from the pneumonectomy site and by major hemodynamic and respiratory embarrassment. All 4 patients required surgical intervention to control the chylous leak.

Chylothorax↗
PubMed1994

A technique for coronary artery reimplantation in composite aortic root replacement.

Currently, three techniques are used for reimplantation of coronary arteries following the insertion of a composite aortic valve graft: Bentall, aortic button, and Cabral interposition graft. We have utilized an alternative technique based on the creation of an inverted U-shaped flap, which is then reflected and sutured to an appropriately sized coronary button. The technique is simple, obviates the needs for coronary mobilization, and assures a tension-free anastomosis and accessible suture line.

Anastomosis, Surgical↗
PubMed1993

Aorto-aortic shunt via the left ventricular apex for operation on the distal arch and the descending aorta.

A technique of aorto-aortic shunt using ordinary non-heparin-bound tubing was used in 21 patients. The proximal limb of the shunt was introduced via the left ventricular apex and advanced through the aortic valve into the ascending aorta, thereby avoiding the difficulty of cannulating the ascending aorta and offering a superior alternative to positioning the proximal limb in the left ventricular cavity.

Adult↗
PubMed1993

An alternative surgical technique in orthotopic cardiac transplantation.

Forty patients underwent orthotopic cardiac transplantation at Wythenshawe Hospital between May 1991 and November 1992. Twenty patients had transplantation using an alternative technique that preserves the shape of the left atrium and leaves the right atrium intact (group A). The remaining twenty had conventional transplantation using the technique described by Lower and Shumway (group B). The patients were randomized to either the new or the conventional technique on an alternate basis. There was no mortality in group A, but two patients in group B developed right ventricular failure and died. Two patients in each group developed nodal rhythm and all four recovered sinus rhythm. Echocardiography and Doppler velocimetry at the transvalvular level confirmed normal atrial function in group A with erratic atrial contraction wave in group B. There was also slightly lower incidence of mitral and tricuspid valve regurgitation in group A than in group B. The improved atrial function in group A may play a part in the prevention of right sided failure following cardiac transplantation.

Echocardiography↗
PubMed1993

Remodeling of the aortic valve anulus.

Isolated aortic valve regurgitation that results from disease that primarily affects the aortic wall can be repaired by remodeling of the aortic anulus to restore its normal geometry. This involves excision of the aortic wall to within 2 to 3 mm of the leaflet attachments, detachment of the coronary ostia, reshaping of the anulus with the aid of a Dacron graft, and then reimplantation of the coronary arteries. Increases in the surface area of the leaflet that are caused by root dilatation are often present and can be accommodated in the repair procedure. In this study we describe our experience with 10 patients with annuloaortic ectasia who underwent the remodeling procedure at the National Heart Hospital and the Royal Brompton Hospital from 1982 to 1990.

Adult↗
PubMed1989

Technique of bronchial closure after pneumonectomy.

Three hundred thirty-two patients had a pneumonectomy at Wythenshawe Hospital, Manchester. England, between 1974 and 1984. In all patients, the bronchus was closed with a posterior flap from the pliable membranous bronchus, leaving no stump, and with the suture line proximal to the carina. In a mean follow-up of 54 months, none of the patients had bronchopleural fistual, and 10 patients had empyema in the pneumonectomy space (3%). A fistula could not be found in any of these patients. The suture material used in closing the bronchus in all these cases was 2-0 chromic catgut, which underlines the fact that bronchial healing is not affected by the type of suture material as long as no tension exists at the suture line.

Adolescent↗
PubMedDate not supplied

Coarctation in teenagers: two new surgical modifications.

BACKGROUND: Definitive surgical procedure for correction of aortic coarctation presenting initially in teenagers, remains an issue. Classic subclavian angioplasty as described by Waldhausen is not recommended after the age 1 or 2 years. Prosthetic patch angioplasty has been associated with an unacceptable incidence of aneurysm formation and resection with end to end anastomosis is not always easy, owing to the development of friable collaterals. METHODS: In the last 4 years, we have utilized two surgical modifications for the treatment of primary isolated coarctation in teenagers. The first is aortoplasty, which relies on minimal resection of the coarctation segment and a plastic procedure of creating four identical flaps from the proximal and distal aorta, the interlocking of which will restore aortic lumen. The second modification is the use of a classic subclavian flap aortoplasty with the addition of a Gore-Tex graft, anastomosed between the upper lateral opening in the suture line and the distal left subclavian artery. Additionally, for the treatment of recurrent coarctation associated with cardiac anomalies, we have utilized the use of adult sized extra-anatomical conduit interposed between the ascending and the descending aorta. RESULTS AND CONCLUSIONS: All three procedures have yielded gratifying results and we believe will increase the options available for the surgeon treating teenagers' coarctation.

Adolescent↗
PubMedDate not supplied

Retrograde pulmonaryplegia for lung preservation in clinical transplantation: a new technique.

Pulmonary artery flush with modified Euro-Collins solution is currently used by many centers for lung preservation. Two limitations with this technique have been that pulmonary artery vasoconstriction necessitates pretreatment of the donor with a prostaglandin and that bronchial circulation, which supplies important nutrients to the intrapulmonary airways, has been ignored. Retrograde pulmonaryplegic solution delivered through the left atrium can perfuse the dual bronchial and pulmonary circulation; furthermore, pulmonary arterial constriction will not affect distribution and may actually enhance it. The technique was used in three successive patients who underwent heart-lung transplantation. Postoperative oxygenation remained excellent; no implantation response occurred, and all three patients were extubated in less than 24 hours. Retrograde pulmonaryplegia offers a simple technique of perfusing both the pulmonary and the bronchial circulation.

Adolescent↗
PubMedDate not supplied

Early pulmonary vein thrombosis after single lung transplantation.

Pulmonary venous obstruction after single lung transplantation may be mistaken for reperfusion injury or myocardial dysfunction. Complete obstruction of one of the major pulmonary veins will result in hemorrhagic infarction of the affected lobe within 4 to 6 hours, limiting the option of treatment to resection (lobectomy) or retransplantation. Early diagnosis is therefore essential. Transesophageal echocardiography can show the pulmonary venous anastomosis and, combined with color flow and Doppler imaging, offer a quick and reliable method of diagnosis. Prevention of this complication entails harvesting an adequate margin of left atrial tissue around the pulmonary vein orifices, meticulous surgical anastomosis, and the use of anticoagulation in the presence of a thrombogenic tendency in the recipient.

Adult↗