Search PubMed⌕ Search

Biomedical subjects

K Momma

Publications and source records attributed to K Momma.

At least 145 records · Page 8Linked to original sources
PubMed1989

Staged operation for pulmonary atresia and ventricular septal defect with major aortopulmonary collateral arteries. New technique for complete unifocalization.

A new staged operation for total correction of pulmonary atresia and ventricular septal defect with major aortopulmonary collateral arteries has been developed. In first-stage repair (complete unifocalization), intrapulmonary arteries were unified at the hilum with equine pericardial conduits (intrapulmonary bridges). In case of absent or severely hypoplastic central pulmonary arteries, new central pulmonary arteries were created. Finally, the unifocalization was completed by modified Blalock-Taussig shunts with the ligation of collateral arteries. In second-stage repair, right ventricular-pulmonary arterial continuity was established with a trileaflet pericardial conduit and closure of the ventricular septal defect. From January 1982 through July 1988, 34 patients, whose ages ranged from 1 month to 24 years (mean 6.6 years), underwent first-stage repair with two resultant late deaths (mortality rate 5.9%). Second-stage repair has been completed in 16 patients. There were two early deaths (mortality rate 12%) from bacterial infection. Postoperative right ventricular/left ventricular systolic pressure ratios ranged from 0.36 to 1.0 (mean 0.72). In four patients in whom the ratio was 1.0, the ventricular septal defect had been closed with a perforated patch. By complete unifocalization with the intrapulmonary bridge technique and the creation of new central pulmonary arteries, the majority of patients with major aortopulmonary collateral arteries can have successful repair.

Aorta↗
PubMed1988

Conotruncal repair of tetralogy of Fallot.

A repair within the conotruncal portion of the right ventricle is introduced. It was used for the intracardiac repair of 30 consecutive patients with tetralogy of Fallot. The infundibular septum was totally resected to reduce the muscular outflow stenosis. Short patch infundibuloplasty with a large monocusp was then used. Instead of the tricuspid septal leaflet, the membranous flap was employed as the suture line for patching the ventricular septal defect (VSD) to avoid a conduction disturbance, residual VSD, and fixing of the tricuspid septal leaflet. The right ventricular (RV) to systemic arterial pressure ratio was 50.0 +/- 14.6% (N = 26) and right atrial pressure was 9.0 +/- 2.5 mm Hg (N = 26) one month after operation. RV end-diastolic volume was 93.0 +/- 30.5% of normal (N = 15) before operation and 96.7 +/- 29.0% of normal one month after operation in the same patients. These data suggest that a conotruncal repair can maintain good RV function with low right atrial pressure and with no increase of RV volume.

Child↗
PubMed1987

An infant with dilated cardiomyopathy confirmed as myocarditis by endomyocardial biopsy.

A case of an 11-month-old infant who was incidentally diagnosed as having myocarditis by right and left ventricular endomyocardial biopsy is reported. This patient was admitted because of heart failure. Chest X-ray showed cardiomegaly and an electrocardiogram revealed decreased voltage with right atrial and right ventricular overloading. A dilated left ventricle with poor ejection fraction was shown in an echocardiogram. Dilated cardiomyopathy was the initial diagnosis since there was no episode of preceding viral infection or evidence of an inflammatory process in routine laboratory investigations. However, the biopsy findings, including massive infiltration of inflammatory cells and myocyte degeneration, indicated myocarditis. To our knowledge, this is the youngest patient in whom myocarditis has been confirmed by endomyocardial biopsy.

Biopsy↗
PubMed1987

Obstruction of the central pulmonary artery after shunt operations in patients with pulmonary atresia.

The central pulmonary artery was studied angiographically 1-10 years after a palliative operation in 56 patients (mean age 6 years, range 1-20) with congenital heart disease and pulmonary atresia. All of them had originally had a central pulmonary artery that was common to both the right and left pulmonary arteries. Juxtaductal obstruction of the left pulmonary artery had developed in 70% of the patients; in 40% the obstruction was atretic unilaterally. Atresia developed at the right junction to the ductus where there was a shunt to the right pulmonary artery and at the left junction where there was a shunt to the left pulmonary artery. Stenosis causing a reduction of more than 50% of the inner diameter developed at the anastomotic site in 10% of 30 patients with a functioning Blalock shunt. In contrast, there was occlusion of the pulmonary artery or its upper branch in 73% of 11 patients with a non-functioning anastomosis.

Adolescent↗
PubMed1987

In vivo constriction of the ductus arteriosus by nonsteroidal antiinflammatory drugs in near-term and preterm fetal rats.

Herein we report age differences of in vivo constriction of the fetal ductus arteriosus by nonsteroidal antiinflammatory drugs in near-term and preterm rats. Two potent nonsteroidal antiinflammatory drugs, indomethacin and flurbiprofen, were studied in preterm (19th and 20th day) and near-term (21st day) rats, whose gestational period was 21.5 days. The time course of fetal ductus constriction was studied on the 20th (preterm fetus) and the 21st (near-term fetus) days of gestation with indomethacin (1 mg/kg, 10 mg/kg) and flurbiprofen (10 mg/kg). In addition, 5 mg/kg of indomethacin was used on the 21st day. Maximal ductal constriction was noticed 8 h after administration. Constriction of the ductus was significantly weaker on the 20th day than on the 21st day in all three studies including indomethacin 1 mg/kg, 10 mg/kg, and flurbiprofen, 10 mg/kg. Dose-response curves were studied at 4 h following administration of indomethacin on the 19th, 20th, and 21st days, and flurbiprofen on the 20th and 21st days. With both drugs, the ductus constricted more vigorously on the 21st day than on the 20th or 19th day. These studies showed a weaker constrictive response of the ductus to nonsteroidal antiinflammatory drugs in the preterm fetus than in the near-term fetus. Twenty-four h after administration of indomethacin on the 20th day, the fetal ductus was dilated, although its plasma indomethacin concentration was high and comparable with that obtained 4 h after administration. These results show that the response of the fetal ductus to indomethacin decreased further at 24 h after administration to preterm rats.

Animals↗
PubMed1987

In situ morphology of the heart and great vessels in fetal and newborn rats.

Morphology of the cardiac chambers and great vessels of fetal and neonatal rats was studied using the whole body freezing technique and by sectioning through the short axis of the heart with a freezing microtome. Compared to the fetal heart, the neonatal heart showed rapid change 2 to 8 days after birth. The ventricular sinus septum was straight in the fetus and became concave to the left ventricle after birth. The right ventricular wall was as thick as the left in the fetus and became thinner rapidly after birth. At the same time, the right ventricular cavity dilated. The right and left pulmonary arteries and pulmonary veins were small in the fetus and enlarged soon after birth. At the same time, the foramen ovale was closed and the diameters of the inferior vena cava and descending aorta were diminished. One-half-mm thick sections were cut serially and then photographed. Ventricular volumes and masses were calculated from summation of the areas of each chambers. Left ventricular mass per body weight increased rapidly after birth, whereas right ventricular mass per body weight remained constant from 0 to 8 days after birth.

Animals↗
PubMed1986

Detection of the drainage site in anomalous pulmonary venous connection by two-dimensional Doppler color flow-mapping echocardiography.

Ten patients with total and one with partial anomalous pulmonary venous connection were studied by two-dimensional Doppler color flow-mapping echocardiography. In cases of anomalous pulmonary venous drainage into the innominate vein through the vertical vein, flow away from the transducer was detected in the echo space behind the atria in the subxiphoid four-chamber approach. In the suprasternal approach, flow toward the transducer was detected at the junction of the vertical and innominate veins. In the case of an anomalous pulmonary vein connecting directly into the superior vena cava, an area of flow toward the transducer, which was triangular in shape, was detected in the dilated superior vena cava. In the two cases in which the pulmonary vein drained into the coronary sinus, the flow toward the transducer was observed at the ostium of the coronary sinus in the subxiphoid four-chamber view, and it appeared as if the blood flow was emerging from this point. In a case of the paracardiac type of total anomalous pulmonary venous connection with drainage into the posterior wall of the right atrium, the flow toward the transducer occurred higher in the right atrium than in the cases with drainage into the coronary sinus. In a case with the infradiaphragmatic type of total anomalous pulmonary venous connection, continuous flow toward the transducer, which passed through the diaphragm in an anomalous vessel, was detected from the subxiphoid area. The downward flow in the anomalous vessel changed to an upward flow at the site of drainage into the hepatic vein.(ABSTRACT TRUNCATED AT 250 WORDS)

Brachiocephalic Veins↗
PubMed1986

Juxtaductal left pulmonary artery obstruction in pulmonary atresia.

The morphology of the central pulmonary artery was studied by selective angiography in 21 previously unoperated patients (aged 11 days-21 years, median 4 years) with pulmonary atresia associated with various types of congenital heart disease. Angiographic findings were confirmed at operation in 10 patients. There was juxtaductal obstruction of the left pulmonary artery in two thirds of the patients with complete atresia in a quarter. Six of seven patients without juxtaductal obstruction had pulmonary valve atresia, but all nine patients with juxtaductal stenosis had truncal atresia. No patient had stenosis of the right pulmonary artery.

Adult↗
PubMed1986

Constriction of the fetal ductus arteriosus by progesterone.

Progesterone substitution in the rat during pregnancy days 17-21 or administration 6 h before spontaneous delivery constricted the fetal ductus arteriosus. The rapid whole-body freezing technique was used. Indomethacin-induced constriction of the fetal ductus arteriosus was not affected by progesterone treatment.

Animals↗
PubMed1986

[Membranous tricuspid atresia with right ventricular dysplasia and absent pulmonary valve: echocardiographic findings in three cases].

Membranous tricuspid atresia with right ventricular dysplasia and absent pulmonary valve is a very rare complex, and a unique type of tricuspid atresia. Three cases with this condition were presented with the echocardiographic evaluation. Two-dimensional echocardiography was performed in all patients, pulsed Doppler echocardiography in two, and contrast echocardiography in two patients. The echocardiographic findings characteristic of this complex were as follows: In the four chamber view, the interatrial and interventricular septa were aligned, and tricuspid valve atresia was of the membranous type. In the four-chamber view, the right ventricular wall was thin, irregular in shape, and it protruded aneurysmally into the left ventricular outflow tract. With systemic venous contrast echocardiography, the right ventricular cavity was opacified with contrast, four to five cardiac cycles after the appearance of contrast in the left ventricle. With pulsed Doppler echocardiography at the main pulmonary artery, antegrade flow was observed in ventricular systole, and retrograde flow in diastole. We conclude that these echocardiographic findings are useful in recognizing the morphology and hemodynamics of this complex.

Child↗
PubMed1985

Characteristic morphology of the constricted fetal ductus arteriosus following maternal administration of indomethacin.

Indomethacin 10 mg/kg was administered to the maternal rat on the 21st day of pregnancy, and the fetal and neonatal ductus arteriosus were studied using the rapid whole-body freezing technique. The sagittal section of the frozen thorax disclosed characteristic localized constriction at the aortic end of the fetal ductus at 24 h after administration of indomethacin. Proximal dilatation of that fetal ductus persisted for more than 4 h after birth, and disappeared gradually. Shortening of the ductal length was associated with both intrauterine constriction by indomethacin in experimental rats and neonatal physiologic constriction of control rats, but significantly greater shortening was seen with intrauterine constriction.

Animals↗
PubMed1984

Natural history of subarterial infundibular ventricular septal defect.

Development of aortic valvular deformities was studied retrospectively in 395 inpatients with subarterial infundibular ventricular septal defect (siVSD). Aortic valvular deformities included prolapse into siVSD without aortic regurgitation (77 patients), prolapse and aortic regurgitation (95 patients), and aneurysm of the sinus of Valsalva (36 patients). No aortic valvular deformity was found in 187 patients, and 111 of these 187 patients had associated pulmonary hypertension. Prolapse and regurgitation of the aortic valve developed most frequently at the age 5 to 8 years. Aneurysm of the sinus of Valsalva was not found before the age of 10 years but began to develop during the teens and was diagnosed most frequently in the twenties. Patients with pulmonary hypertension did not develop aortic valvular deformities except in one instance. All inpatients with siVSD and without pulmonary hypertension over the age of 30 years had developed some aortic valvular deformities.

Adolescent↗
PubMed1984

Constriction of fetal ductus arteriosus by non-steroidal anti-inflammatory drugs:study of additional 34 drugs.

Our study on transplacental effects of 24 non-steroidal anti-inflammatory drugs (NSAID) on the fetal ductus arteriosus of full-term pregnant rats was extended to 34 other NSAID using the same whole-body freezing technique (1). In total, 58 NSAID were evaluated, and their potency in usual clinical doses was classified into 4 grades. Indomethacin and 15 other NSAID caused strong fetal ductal constriction, phenylbutazone and 14 other NSAID caused moderate, and aspirin and 16 other NSAID caused mild constriction of the fetal ductus arteriosus. Salicylamides, and six out of eight basic NSAID did not constrict the fetal ductus arteriosus. Further clinical implications of these results are discussed.

Animals↗
PubMed1984

[External conduit repair for congenital heart diseases].

Between January 1970 and March 1984, external conduit repair was performed in eighty-five consecutive patients for various complex anomalies. The age at operation ranged from 2 months to 47 years, and 41 patients were in an age group of 5 to 9 years. Among 85 complex anomalies, 20 cases of d-transposition with VSD + PS, 33 cases of Tetralogy of Fallot with pulmonary atresia, 11 cases of truncus arteriosus and 11 cases of 1-transposition were included. From January 1970 to December 1975, conduits used were aortic homograft in 1, formalin treated porcine valved conduits in 27, and valved conduits treated with 0.65% glutaraldehyde in 3 and from January 1976 to November 1982, 42 Hancock composite grafts were used. Since December 1982, valved conduits made of preserved pericardium treated with glutaraldehyde were employed. In sixty-one patients survived from operation, actuarial survival rate was calculated as 87% at five years, 82% at ten to fourteen years. However, systolic pressure of right ventricle after repair mostly affected actuarial survival rate which maintained 93% at twelve years in patients with systolic pressure lower than 80 mmHg, and reduced to 65% at fourteen years in patients with that higher than 80 mmHg. Although external conduit repair was valuable for surgical treatment in complex anomalies, proper selection of conduit material, prevention of infectious endocarditis, and pseudoendothelial proliferation in late stage were the problems to be solved in the future.

Adolescent↗
PubMed1983

Pulmonary arteriography through patent ductus arteriosus with preformed catheters.

Selective pulmonary arteriography was performed successfully with new preformed catheters in eight consecutive patients with pulmonary atresia or severe stenosis and patent ductus arteriosus. The catheters were inserted percutaneously into the femoral artery and passed into the patent ductus arteriosus very easily within a few minutes. Pulmonary arteriography was performed with biplane cineangiography. All eight patients showed either stenosis or secondary atresia in the central pulmonary artery. The obstructive lesions occurred at the junction of either a patent ductus arteriosus or a surgically anastomosed subclavian artery.

Adult↗
PubMed1983

Constriction of fetal ductus arteriosus by non-steroidal anti-inflammatory drugs.

Transplacental effects of 24 non-steroidal anti-inflammatory drugs (NSAIDs) on the fetal ductus arteriosus were studied in full-term pregnant rats using the whole-body freezing technique. All sixteen acidic NSAIDs constricted the fetal ductus in a dose-dependent relationship, but considerable differences in the intensity of effect was noticed with the clinical dose of each drug. Six of the eight basic NSAIDs did not constrict the fetal ductus at 50 to 100 times the usual clinical dose. It is concluded that acidic NSAIDs probably should not be administered to pregnant women. However, it may be established in the future that some basic NSAIDs can be administered safely to pregnant women without hazardous effect on the fetus.

Age Factors↗