Complete revascularization of the left anterior descending coronary artery.

Objective: To assess the efficacy of complete revascularization of the left anterior descending coronary artery.

Methods: To obtain such revascularization, 81 patients required the use of such complex techniques as the onlay patch technique or double bypasses during bypass grafting.

Results: The onlay patch technique was used in 39 (48%) and double bypasses in 42 (52%).

Increased plasma antigen levels of monocyte chemoattractant protein-1 in patients with restenosis after percutaneous transluminal coronary angioplasty.

Monocyte chemoattractant protein-1 (MCP-1) plays an important role in the progression of atherosclerosis in coronary arteries. To examine whether or not plasma antigen levels of MCP-1 are related to restenosis after percutaneous transluminal coronary angioplasty (PTCA), the plasma antigen levels of MCP-1 were measured by enzyme-linked immunosorbent assay (pg/ml) before, 24 and 48 h, and 3 months after elective PTCA for stable exertional angina performed between June 1997 and March 1998. Restenosis was defined as recurrence of stenosis greater than 50% of the diameter in the dilated segment at 3-month follow-up angiography.

The effect of heparin on tissue factor and tissue factor pathway inhibitor in patients with acute myocardial infarction.

We examined plasma TF and free TFPI levels in 26 consecutive patients with AMI, 26 patients with stable exertional angina, and 25 patients with chest pain syndrome. In patients with AMI, blood samples were obtained immediately after admission and at 4, 8, 16, 24, and 48 h, and the third, fifth, seventh, and fourteenth day after initiation of reperfusion therapy. Plasma TF levels in patients with AMI on admission were significantly higher than in the chest pain syndrome and stable exertional angina groups (248.

[Surgical results of valvular heart disease combined with myocardial revascularization].

Risk factors for hospital death after combined valvular and coronary artery bypass surgery were examined in 131 consecutive cases between October 1988 and December 1999. These accounted for 8.0% of all 1,644 cases of coronary revascularization surgery and 15.

Long-term results of root reconstruction using the Carrel patch.

Objective: The treatment of annuloaortic ectasia in patients, including those with Marfan syndrome, ascending aortic dissection, and other disorders of the ascending aorta and aortic valve presents a surgical challenge that has, unfortunately, shown high hospital mortality up to now. Improvements in graft materials and advanced surgical techniques have, however, begun to reduce hospital mortality.

Subjects And Methods: We retrospectively analyzed the records of 47 consecutive patients who undergoing aortic root reconstruction using the Carrel patch between January 1991 and March 1999.

Diagnostic Brachial Coronary Arteriography Using a Power-Assisted Injector and 4 French Catheters with New Shapes.

BACKGROUND: Right brachial access in diagnostic coronary arteriography (CAG) has demonstrated advantages over femoral approaches, including earlier ambulation and more predictable hemostasis, particularly when small diameter catheters were used. Poor results from some earlier reports of brachial CAG have been due partially to the need to use large diameter catheters for positional control. Technical advances in catheters and contrast injection may increase the utility of brachial access CAG.

Ultrasonographic demonstration of manipulation-related aortic injuries after cardiac surgery.

Objectives: This study was performed to evaluate the frequency and risk factors associated with new aortal lesions induced by surgical manipulation and their correlation with postoperative stroke.

Background: Little is known about the causative mechanism of intraoperative atheroembolism after cardiac surgery.

Methods: Epiaortic echocardiography was performed before cannulation and after decannulation in 472 patients undergoing cardiac surgery with extracorporeal circulation.

Evaluation of new 4 French catheters by comparison to 6 French coronary artery images.

The use of 4 Fr catheters for diagnostic coronary arteriography improves patient comfort and could potentially reduce costs by decreasing arterial complications and encouraging outpatient examination. We examined the performance of recently developed 4 Fr catheters (100 cm long, 0.042 inch internal diameter) through in vitro flow rate patterns and in vivo image quality.

Analysis by early angiography of right internal thoracic artery grafting via the transverse sinus : predictors of graft failure.

Background: There has been debate regarding whether technically demanding right internal thoracic artery (RITA) grafting via the transverse sinus can be extensively applied to patients in high-risk groups, such as patients with a small body size, elderly patients, and woman with relatively smaller coronary artery and internal thoracic artery (ITA) diameters.

Methods And Results: Of the 1456 patients who underwent isolated coronary artery bypass grafting between January 1989 and December 1998 at Kumamoto Central Hospital, 393 patients (mean age, 62.4+/-9.

Relation between coronary thrombus and angiographic no-flow during primary angioplasty in patients with acute myocardial infarction.

No flow is an unsolved issue in primary percutaneous transluminal coronary angioplasty (PTCA) for patients with acute myocardial infarction (AMI), and the pathophysiology of no-flow is undetermined. To evaluate the potential participation of coronary thromboembolism in no-flow during primary PTCA, the present study reviewed cinefilms of 256 consecutive patients who underwent primary PTCA for AMI within 24h after the onset of chest pain between January 1992 and June 1998, focusing on the thrombus size. Angiographic no-flow was defined as the cessation of flow into the distal coronary circulation of the treated vessel with a to-and-fro contrast movement, not attributable to high-grade stenosis or spasm of the original target lesion.

Coronary artery bypass grafting in dialysis patients.

Background: To analyze the characteristic problems of coronary artery bypass grafting in patients with chronic renal failure.

Methods: Fifty-one consecutive dialysis patients who required isolated coronary bypass grafting over a 9-year period were studied retrospectively.

Results: Nine patients (18%) had emergent operation, 4 of whom had intraaortic balloon counterpulsation instituted preoperatively.

Bileaflet mechanical valve (St. Jude Medical valve) replacement in long-term dialysis patients.

Background: Few reports exist on the results of bileaflet mechanical valve (St. Jude Medical prosthesis; St. Jude Medical, Inc, St.

In situ right internal thoracic artery graft for revascularization of circumflex artery. Early results and long-term angiographic follow up.

In 285 patients, the right internal thoracic artery, routed through the transverse sinus, was in most cases anastomosed to the circumflex branches. In 278 cases, the left internal thoracic artery was simultaneously used for revascularization of the left anterior descending artery. Two patients died (mortality rate 0.

Coronary artery bypass grafting in patients with systemic lupus erythematosus.

Objective: Few reports exist on the results of coronary artery bypass grafting (CABG) in patients with systemic lupus erythematosus (SLE).

Methods: We retrospectively reviewed eight CABG in seven SLE patients. In early and late postoperative angiography, all grafts were evaluated for occlusion, development of string sign, or presence of significant stenosis.

[Evaluation of the results of the combined maze procedure for chronic atrial fibrillation with organic heart disease].

To examine the surgical indications and the results of the maze procedure, we reviewed 30 cases who underwent the maze procedure concomitantly with other open heart surgery from October 1995 to October 1997.: the average age was 60.9 years (37 to 75 years) and mean follow up period was 12.

Extracorporeal circulation before and after ultrasonographic evaluation of the ascending aorta.

Background: To further gain insight into atheroembolization mechanisms epiaortic two-dimensional echocardiographic evaluation before extracorporeal circulation and after decannulation may be helpful.

Methods: Epiaortic two-dimensional echocardiography was performed before cannulation and after decannulation in 188 (124 men) patients (mean age, 67.7 years; range, 43 to 86 years) undergoing operation with extracorporeal circulation for ischemic heart disease during 1996.

Outcome of target sites escaping high-grade (>70%) restenosis after percutaneous transluminal coronary angioplasty.

This study examined the fate of target sites that escaped high-grade restenosis (> or = 70% diameter narrowing) after percutaneous transluminal coronary angioplasty. Although favorable long-term prognosis after successful percutaneous transluminal coronary angioplasty is well documented, little is known about the stability of target sites. Long-term follow-up (mean 6.

Percutaneous transluminal coronary angioplasty, alone or in combination with urokinase therapy, during acute myocardial infarction.

To investigate the effect of pre-treatment of a thrombus with a low dose of urokinase on establishing patency in a persistent infarct-related artery (IRA) during direct percutaneous coronary angioplasty (PTCA), the frequency of acute restenosis during direct PTCA, alone, or in combination with the intracoronary administration of urokinase, was examined in a consecutive nonrandomized series of patients with acute myocardial infarction (AMI). Two hundred and seventy-two successful PTCA patients (residual stenosis <50%) were divided into 2 groups: 88 patients received pre-treatment with intracoronary urokinase following PTCA (combination group); 184 received only direct PTCA without thrombolytic therapy (PTCA group). In the present study, after achievement of a residual stenosis of less than 50%, IRA was visualized every 15 min to assess the frequency of acute restenosis, which was defined as an acute progression of IRA with more than 75% restenosis after initially successful PTCA.

Long-term patency rate of right internal thoracic artery bypass via the transverse sinus.

Background: Although concern regarding patency and possible compromise of graft blood flow by routing the right internal thoracic artery (RITA) through the transverse sinus has been raised, little is known about long-term patency.

Methods And Results: To evaluate long-term patency of in situ RITA bypass via the transverse sinus, our first 115 patients (94 men, 21 women; mean age, 62.5 years; range, 13 to 77 years) who were alive in 1998 were enrolled for angiographic study.

[An evaluation of cases carried out by both root reconstruction using Carrel patch method and concomitant procedure].

During the past 7 years from January 1991 to November 1997, we experienced 31 cases of aortic root reconstruction utilizing Carrel patch method. Concomitant procedure were performed in 9 cases of them due to another cardiovascular disease. Complicated cardiovascular disease included 3 cases of ischemic heart disease, 3 cases mitral regurgitation and one case of Aortic arch aneurysm.

[Mitral valve regurgitation with anterior mitral leaflet chordal rupture or elongation--repair using the flip-over technique].

Repair of prolapsed anterior mitral leaflet has remained technically difficult. The purpose of this study was to assess the clinical results after using the flip-over technique for patients with anterior mitral leaflet prolapse due to dhordal rupture or elongation. Between January 1993 and September 1997, fifteen adult patients with pure mitral valve regurgitation (MR) due to prolapse of the anterior mitral leaflet underwent repair using the flip-over technique.

Angiographic evaluation of culprit lesions in acute coronary syndrome: relation to the original site on previous coronary angiography.

Culprit lesions in acute coronary syndrome [acute myocardial infarction (AMI) and unstable angina pectoris (UAP)] were examined angiographically in 222 patients who had previously undergone coronary angiography (CAG). The observation period lasted 5 years after primary CAG in medically treated patients (group M, 127 cases) and after final follow-up CAG in patients treated by percutaneous transluminal coronary angioplasty (PTCA) (group B, 95 cases). There were 33 AMIs, including 5 deaths (22/127, 17.

Two cases of adult varicella accompanied by hepatic dysfunction.

Varicella is a typical acute exanthematous viral infection caused by varicella-zoster virus (VZV). In recently years, as far as hepatic dysfunction caused by viruses other than the hepatitis virus is concerned, there have been a few reports on hepatic dysfunction accompanying varicella following organ transplantation of Europe and America and another report on an immunocompromized adult following treatment for Systemic lupus erythematosis (SLE) in Japan. Nonetheless, we searched the MEDLINE and J MEDICINE listing the publications between 1986 and 1996 and found one report on healthy adults with varicella accompanied by hepatic dysfunction in Europe and America and two reports in Japan.

[The propriety of bilateral internal thoracic artery grafting in women].

In our institution, the exclusion criteria of the bilateral internal thoracic artery (BITA) grafting include age over 70 years old, obesity, severe diabetes, renal dysfunction and poor preoperative physical activity. The objective of this study is to evaluate propriety of the use of bilateral internal thoracic artery for coronary artery bypass grafting (CABG) in women. Clinical outcome of female patients who underwent BITA grafting (group B-F; n = 50) was compared with that of female patients who underwent single internal thoracic artery grafting (group S; n = 50).

The effects of the angiotensin-converting enzyme inhibitor imidapril on plasma plasminogen activator inhibitor activity in patients with acute myocardial infarction.

This study sought to determine whether early treatment with angiotensin-converting enzyme (ACE) inhibitors in patients with acute myocardial infarction (AMI) is useful for the improvement of fibrinolytic function, as well as left ventricular function. This study was designed to examine the levels of plasma plasminogen activator inhibitor (PAI) activity and serum ACE activity during the course of 2 weeks in 40 patients with AMI within 12 hours after the onset of the symptom and who randomly received early treatment with either the ACE inhibitor imidapril or a placebo (20 patients in the imidapril group and 20 in the placebo group). The levels of serum ACE activity in the imidapril group decreased significantly (p < 0.