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Biomedical subjects

M Komeda

Publications and source records attributed to M Komeda.

At least 109 records · Page 6Linked to original sources
PubMed1989

[Successful mitral valve repair and myocardial revascularization in an infant with anomalous origin of the left coronary artery from the pulmonary artery].

An 8-month-old girl of anomalous origin of the left coronary artery from the pulmonary artery associated with severe mitral regurgitation underwent radical operation. She had been in serious cardiac and respiratory failure. Aorto-left coronary arterial continuity was established by intrapulmonary arterial tunnel using Takeuchi's technique. Mitral annulus was plicated by modified Kay's technique. Post-operative course was uneventful.

Coronary Vessel Anomalies↗
PubMed1989

Surgical treatment of aortic root abscess.

A significant number of patients with infective aortic valve endocarditis develop aortic annular abscess. Although antibiotics may occasionally sterilize an aortic root abscess, most patients require surgical intervention. A review of our experience with 21 consecutive patients surgically treated for aortic root abscess disclosed that 13 patients had prosthetic valve and eight had native aortic valve endocarditis. The predominant microorganism was Staphylococcus aureus, particularly in those patients with native aortic valve endocarditis. The abscess was limited to the aortic annulus in 10 patients and was either multiple or had perforated the left ventricular outflow tract in 11 patients. Most patients were desperately ill at the time of operation. Repair was accomplished by aggressive debridement of all apparently infected tissue and reconstruction of the left ventricular outflow tract with autologous pericardium. Although postoperative complications were common, only one patient died in hospital. Operative survivors have been followed up from 3 to 68 months (mean, 29 months). One patient died of complications of repair of a thoracoabdominal aneurysm 34 months after surgery; his prosthetic aortic valve and patch were intact at autopsy. No patient has experienced recurrent infection, pericardial patch aneurysm, or prosthetic valve dehiscence.

Abscess↗
PubMed1988

Mitral valve replacement with preservation of chordae tendineae and papillary muscles.

An operative technique for mitral valve replacement (MVR) with preservation of the chordae tendineae to the anterior leaflet as well as the posterior leaflet is reported. This technique consists of the division of the anterior leaflet into anterior and posterior segments, the shifting and reattachment of the divided segments to the mitral ring of the respective commissural areas, and the use of a low-profile bileaflet prosthetic valve. A comparison of left ventricular function data between patients having operation with this technique and those having operation with the conventional method of MVR revealed significantly better improvement in cardiac index (p less than 0.06), left ventricular end-systolic volume index (p less than 0.05), and left ventricular ejection fraction (p less than 0.10) in the former group. Left ventricular wall motion improved in the anterolateral (p less than 0.01) and apical areas (p less than 0.02) in patients operated on with our technique. Maintenance of continuity between the mitral annulus and papillary muscles is expected to have a beneficial effect on postoperative left ventricular performance in spite of increased afterload.

Adult↗
PubMed1988

Evaluation of corrective surgery for tetralogy of Fallot from late results by multivariate statistical analysis.

From 1966 to 1985, 469 pediatric patients with the tetralogy of Fallot (mean age, 4.9 years) were corrected (hospital mortality 11.9%). There were 9 late deaths (1.9%). In 186 patients, hemodynamic studies were performed 2-14 years postoperatively (mean age, 10.4 years). An increased cardiothoracic ratio (CTR) of 60% or more was found in 42 patients with impaired postoperative physical activity. The factors affecting the late results were investigated in relation to CTR by the quantification method of multivariate analysis. As for the enlarged CTR, pulmonary regurgitation was more of a contributing factor than pulmonary stenosis. In pulmonary regurgitation, the pulmonary artery area index (PAAI) and reconstruction of the right ventricular outflow tract (RVOT) were highly significant factors. For pressure gradient, the VSD site was the most significant factor. These analyses suggest that preservation and/or reconstruction of the pulmonary valve, or trans-annular patching with the necessary minimal area for the RVOT (PAAI) not to exceed 4 cm2/m2 at the time of operation is important for satisfactory late results.

Adolescent↗
PubMed1988

Massive systemic venous thrombosis after Fontan operation: report of a case.

A 7 year old boy with single ventricle with pulmonary stenosis underwent a modified Fontan procedure. He had a very stormy postoperative course complicated by continued pleural effusion, hepatomegaly, and chylothorax. He eventually died after an atrial septum reopening. At autopsy, massive thrombi were found in the inferior vena cava, right atrium, and pulmonary artery. This complication was probably due to multiple factors, but a routine anticoagulation therapy may be required after Fontan procedure.

Cardiac Surgical Procedures↗
PubMed1988

Early and late results of reconstructive operation for congenital mitral regurgitation in pediatric age group.

Sixty-six children aged between 8 months and 15 years (average age 5.5 +/- 3.8 years) underwent mitral reconstructive operations for congenital mitral regurgitation between June 1969 and February 1987. The pathologic findings of the mitral valves were annular dilatation in 37 patients, cleft of the leaflet in eight, hypoplasia of the leaflet in 44, perforation of the leaflet in one, chordal elongation in 22, chordal absence in 16, and chordal shortening in seven. The methods of repair consisted of asymmetric annuloplasty (Kay-Reed method) in 61 patients, De Vega-type annuloplasty in one, plication of redundant leaflet in 15, and closure of cleft or perforation in nine. The single operative death (1.5%) was due to heart block. Follow-up data were available over 373.8 patient-years (average 5.7 years). The four late deaths (6.0%) were due to heart failure in two patients, pneumonia in one, and hepatitis in one. The actuarial survival rate was 93.1% +/- 3.1% at 7 years and 88.4% +/- 5.1% after 17 years. Valvuloplasty failed in 19 of the long-term survivors. One of these patients underwent mitral valve replacement 11 years after initial operation. The rate of freedom from reoperation was 86% +/- 10% after 17 years. The rate of freedom from valvuloplasty failure was 80% +/- 6.7% after 5 years, 67% +/- 7.2% after 10 years, and 44% +/- 11.9% after 15 years.

Adolescent↗
PubMed1987

Usefulness of electromagnetic flowmetry in intraoperative evaluation of aortic regurgitation associated with ventricular septal defect.

In 38 patients with aortic regurgitation (AR) associated with ventricular septal defect (VSD), indications for aortic valvuloplasty (AVP) or aortic valve replacement (AVR) were investigated by assessing AR ratio, which was measured by electromagnetic flowmetry of the ascending aorta during the operation. Residual AR was evaluated by auscultation postoperatively. Patients were assigned to group A if they underwent VSD closure alone and to group B if they underwent AVP in addition to VSD closure; patients who had no postoperative AR were assigned to group I and those with persistence of AR to group II. Thus, the patients were separated into 4 subgroups; A-I (9 patients), A-II (5 patients), B-I (20 patients) and B-II (4 patients). In subgroup A-I, mean AR ratio decreased from 9% to 7% postoperatively, in A-II from 19% to 16% (p less than 0.1), in B-I from 36% to 9% (p less than 0.01) and in B-II from 44% to 20% (p less than 0.05). An AR ratio of more than 25% should be regarded as an absolute indication for AVP or AVR. If the AR ratio is between 20 and 25%, the indication of AVP is determined by inspection of the aortic valve. A good correlation was found between AR ratio and the AR rate determined by the aortic angiographic findings (Sellers classification): grade I AR corresponded to an AR ratio of 5 to 15%, grade II to 20 to 35%, grade III to 25 to 50% and grade IV to 45% or higher (r = 0.87, p less than 0.01).

Aortic Valve↗
PubMed1987

Optimal flow of aorta-pulmonary artery shunt in patients with cyanotic heart disease.

An aorta-pulmonary artery shunt with an expanded polytetrafluoroethylene (Gore-Tex) tube graft (3 to 6 mm in diameter) was done in 33 cyanotic patients with complex congenital heart disease. The patients ranged from 14 days to 22 years old. In 28, the shunt flow (QB) was measured, and the optimal QB and graft size were determined. Nine patients had severe heart failure because of an excessively large shunt. Seven of these patients died, 5 early and 2 late after operation. The QBS in these 9 patients were extremely high; the QB index and the ratio of shunt flow to systemic flow (QB/QS) were 3.86 +/- 0.91 L/min/m2 (mean +/- standard deviation) and 52.4 +/- 9.7%, respectively. The QB index and the QB/QS of patients without severe cardiac failure were 1.49 +/- 0.92 L/min/m2 and 27.2 +/- 11.4%, respectively. In conclusion, the QB index, the QB/QS, or both should be maintained in the range of 1.6 to 2.4 L/min/m2 and 30 to 40%, respectively. In infants, however, it is advisable to control the flow at less than the range just given. Analysis of graft size in relation to body weight (BW, in kilograms) and body surface area (BSA, in square meters) showed that the optimal diameter (D, in millimeters) could be calculated by the following formulas: D = 1.88 In(BW) + 1.8 (r = .86) D = 0.87 In(BSA) + 5.3 (r = .73).

Aorta, Thoracic↗
PubMed1987

A giant aneurysm of the non-coronary sinus of Valsalva.

A 54-year-old woman complained of shortness of breath. She was diagnosed to have an aneurysm of the non-coronary sinus and underwent a radical operation. The aneurysm had a diameter of 10 cm. Superior vena cava, right atrium, and right ventricle were severely compressed and deformed. The non-coronary sinus and ascending aorta were reconstructed with a 24 mm Dacron graft using the graft inclusion technique. The ostiums of both coronary arteries were skirted. The postoperative course was uneventful.

Angiocardiography↗