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Biomedical subjects

S Kanemoto

Publications and source records attributed to S Kanemoto.

At least 19 recordsLinked to original sources
PubMed2001

[Surgical techniques and results of right ventricular [correction of venericular] outflow tract reconstruction with pedicled autologous tissue].

From 1987 to 2000, 44 patients underwent anatomic repair of anomalies with pulmonary outflow obstruction by using pedicled autologous tissue in reconstructing the pulmonary outflow tract. Twenty-four patients had tetralogy of Fallot with pulmonary atresia (TOF/PA), from 1.7 years to 12.9 years of age (mean 9.0 years). In the group of TOF/PA, slit-widening method was performed in 22, autologous pericardial flap was used in 1, and atrial appendage was used in 4 patients. Eight patients had transposition of the great arteries with ventricular septal defect and pulmonary stenosis (TGA type III), from 9 months to 9.2 years of age (mean 4.5 years). All of the patient with TGA type III under went direct PA-RV anastomosis (natural route non-conduit repair). Three patients had truncus arteriosus, from 1 month to 7.8 years of age (mean 4.5 years). In the group of the truncus, atrial appendage was used in 1 and direct PA-RV anstomosis was made in 2 patients. Six patients had Rastelli's conduit obstruction, from 6.6 years to 20.3 years of age (mean 13.9 years). The conduit was removed and outflow tract was reconstructed with direct PA-RV anastomosis in 5 and using atrial appendage in 1 patients. There was one hospital death (2%) and no late deaths. In 31 patients whose follow-up time exceed 5 years, 7 patients (23%) were found to have pressure gradient more than 40 mmHg at the pulmonary outflow tract. None of the patients with TGA who underwent natural route non-conduit repair developed late stenosis at the pulmonary out flow tract.

Cardiac Surgical Procedures↗
PubMed1998

Right ventricular obstruction by tricuspid pouch in simple ventricular septal defect.

Tricuspid pouch sometimes causes subpulmonary obstruction in association with transposition of the great arteries, but rarely does so without transposition. A 5-year-old girl with isolated ventricular septal defect exhibited dynamic right ventricular outflow tract obstruction caused by pouches in the anterior and septal tricuspid leaflets. Echocardiography clearly demonstrated features of the tricuspid pouches. Ventricular septal defect closure resulted in disappearance of the tricuspid pouches and resolution of subpulmonary obstruction.

Child, Preschool↗
PubMed1998

Anastomosis of the left juxtaposed atrial appendages in a patient with tricuspid atresia.

A 9-month-old boy with left juxtaposition of the atrial appendages, tricuspid atresia, pulmonary atresia, and ventriculoarterial discordance underwent anastomosis between the atrial appendages after failure of balloon/blade atrial septostomy because of restrictive atrial septal defect. For surgical creation of atrial communication in patients with juxtaposed atrial appendages, anastomosis between the atrial appendages seemed to be safer, more effective, and less invasive than septectomy by Blalock-Hanlon technique or inflow occlusion technique.

Anastomosis, Surgical↗
PubMed1998

Repair of septal and posterior tricuspid leaflets in Ebstein's anomaly.

BACKGROUND AND AIM: In Ebstein's anomaly, the septal and posterior tricuspid leaflets are plastered to the endocardium. We postulated that tricuspid valve function could be corrected by restoring mobility of these leaflets. (Feasibility of such repair was explored by anatomical and clinical studies.) METHODS: Ten heart specimens with Ebstein's anomaly were examined to investigate the size of the tricuspid leaflets. We operated on four patients with Ebstein's anomaly: the plastered septal and posterior leaflets were mobilized from the endocardium, the atrialized right ventricle was longitudinally plicated, and the basal attachment of the mobilized leaflets was sutured (reattached) to the valve annulus. RESULTS: In heart specimens, approximately 40% of the total surface of the tricuspid leaflets was comprised of the septal and posterior leaflets. Clinically, all patients operated on returned to normal functional status after surgery. The mean cardiothoracic ratio on chest X-rays decreased from 0.70 to 0.55 (after surgery). Echocardiographic tricuspid regurgitation, graded from 0 to 4, decreased from 3.5 to 1.0, and tricuspid annular diameter ratio to the normal value reduced from 1.88 to 0.66. Angiographic right ventricular ejection fraction increased from 0.36 to 0.50, and end-diastolic volume ratio to the normal value decreased from 3.65 to 1.19. CONCLUSIONS: Repair of the septal and posterior tricuspid leaflets was found to be feasible and effective as tricuspid valvuloplasty for Ebstein's anomaly.

Adolescent↗
PubMed1998

[A case report: right ventricular outflow tract (RVOT) reconstruction using homograft for RVOT restenosis after Jatene's procedure of transposition of the great arteries (TGA)].

A 7-year-old boy was admitted for RVOT restenosis. The patient was born following an unremarkable pregnancy and delivery. He was carried out Jatene's procedure for TGA at 23rd day after birth. At 19 month of age, he was removed pulmonary stenosis using patch angioplasty with mono cusp. When he was 6 year of age, the onset of edem, ascites and hepatomegaly were pointed out. At 7 year of age, he was admitted for edema, hypoproteinemia and protein loosing enteropatchy. After he was treated medical therapy, cardiac catheterization showed markedly right atrial and right ventricular hypertension and ventricular septal defect (VSD). Cine angiography suggested the right ventricular outflow tract stenosis, pulmonary valve and tricuspid valve insufficiency. On August 1, 1996, the patient underwent surgical repair: direct closure of VSD, aortic homograft (20mm) replacement for RVOT stenosis and tricuspid valve annuloplasty by DeVega's procedure. Postoperative course was uneventful. At 23rd postoperative day, cardiac catheterization and cine angiography showed no problems. He was not treated with anticoagulation.

Aorta↗
PubMed1998

[Hemodynamic effects of amrinone or milrinone in infant after right heart bypass operation].

After right heart bypass operation, dopamine was continuously infused at 5 micrograms/kg/min. The patients had a stable hemodynamic status but relatively low SvO2, low urine output and peripheral insufficiency. Amrinone was continuously infused at 10 micrograms/kg/min in 5 patients (Group A), or milrinone was continuously infused at 0.5 microgram/kg/min in 5 patients (Group M). After infusion of amrinone or milrinone, arterial blood pressure relatively decreased and heart rate relatively increased. But heart work index did not increased. SvO2 relatively increased. Mean pulmonary artery pressure relatively decreased. The administration of amrinone (Group A) produced relatively thrombocytopenia compared with milrinone (Group M). Two patients had supraventricular arrhythmia in Group A. A patient had ventricular arrhythmia and another patient supraventicular arrhythmia. These patients treated using temporary antiarrhythmia drug or temporary pacing. When the patients discharged, they recovered the normal sinus rhythm. In conclusion, after right heart bypass operation in infants, infusion of amrinone or milrinone appears to be effective and safe combining with dopamine.

Amrinone↗
PubMed1997

Lay-open pulmonary arterioplasty for postoperative hilar pulmonary artery stenosis.

OBJECTIVE: Lay-open pulmonary arterioplasty, a novel surgical technique to enlarge postoperative stenosis at the hilar pulmonary artery, was evaluated. METHODS: Lay-open arterioplasty, in which the enlarged hilar stenotic pulmonary artery is partially made up of previous surgical scar tissue instead of being covered by a patch, was performed on 10 patients whose ages ranged from 2.2 to 15.7 years. Surgical results were assessed by angiography. RESULTS: All patients tolerated the procedure without bleeding or embolic complications associated with pulmonary arterioplasty. Nine patients underwent concomitant procedures including total repair (n = 5), central interposing shunt (n = 3), and right ventricular outflow tract reconstruction (n = 1). No deaths or life-threatening events occurred during the total follow-up period of 18 patient-years. The stenotic segment was significantly enlarged from the preoperative diameter of 0.9 +/- 1.1 mm (mean +/- standard deviation) to the postoperative diameter of 8.0 +/- 1.3 mm, values which correspond to 7.0% +/- 8.8% and 68.4% +/- 11.5% of the normative values, respectively. A follow-up angiogram (n = 5) revealed an increase in the pulmonary artery diameter balanced with somatic growth (initial value, 65.2% +/- 9.0% of normal; second value, 69.1% +/- 7.7% of normal). No aneurysms or clinically significant restenoses were seen on the angiograms. CONCLUSIONS: Our initial midterm results with this method were promising. The pulmonary arteries subjected to this procedure grew in proportion to somatic growth.

Angioplasty↗
PubMed1997

Simultaneous detection of Streptococcus pneumoniae and Haemophilus influenzae by nested PCR amplification from cerebrospinal fluid samples.

Haemophilus influenzae and Streptococcus pneumoniae are often the cause of serious diseases such as meningitis. We designed a nested PCR assay to identify these pathogens from cerebrospinal fluid samples. The first-step PCR was able to detect eubacterial rRNA genes with a unified set of universal primers. In the second-step PCR, the identification primers, HI I and II and SP I and II, could detect H. influenzae and S. pneumoniae respectively through amplification of the rRNA spacer between the 16S and 23S rRNA genes. We suggest that the two-step PCR assay can be used as a novel method for the immediate and retrospective diagnosis of bacterial meningitis caused by H. influenzae and S. pneumoniae.

Cerebrospinal Fluid↗
PubMed1997

[Bacterial culture of the anterior chest skin for prophylaxis in cardiovascular operations: prospective study in two civilian hospitals].

Mediastinitis after median stermotomy is a significant complication for a cardiovascular surgery. Prospective study of bacterial cultures of the anterior chest skin in cardiac and aortic surgery was performed with the comparison of two civilian hospitals. There were many ABPC-resistant bacteria including 26 to 67 percent of Staphylococcus epidermidis (SE). ABPC could not be chosen for the first drug of prophylaxis. Although there was a few CEZ-resistant SE, the efficacy of first-generation cephalosporins was acceptable in this series. If methicillin-resistant Staphylococcus aureus (MRSA) is detected in patient's preoperative bacterial cultures, vancomycin should be selected for prophylaxis. In patients with poor risk who required emergent cardiac surgery, combinational use of an first-generation cephalosporin and an amikacin or a minocycline should be recommended in our data.

Adult↗
PubMed1996

[Inhaled nitric oxide for postoperative pulmonary hypertensive crisis in a patient with complete atrioventricular canal associated with Down's syndrome: a case report].

Two-year-old boy with Down's syndrome was treated with inhaled nitric oxide for pulmonary hypertensive crisis after correction of complete atrioventricular canal and persistent ductus arteriosus. The acute rise in pulmonary pressure and hemodynamic instability occurred on 3rd, 4th and 6th post operative days and pulmonary vasodilation with prostaglandin E1 and amrinone had failed. Twenty ppm of inhaled nitric oxide effectively reduced the pulmonary pressure and the patient was subsequently weaned from ventilation. Inhaled nitric oxide exerted a pulmonary vasodilation without decreasing systemic pressure in this patient with postoperative pulmonary hypertensive crisis.

Acute Disease↗
PubMed1996

[Management of postoperative pulmonary hypertensive crisis in children--indication and usefulness of inhaled nitric oxide therapy as a pulmonary vasodilator].

Among 176 pediatric patients who underwent open heart surgery from 1990 to 1996, 7 developed severe pulmonary hypertensive crisis (PHC) postoperatively. All patients were treated with conventional medical therapy consisting of hyperventilation and deep sedation. Prostaglandin E1 and/or amrinone were administered initially as a pulmonary vasodilator, and in 3 of the 7 patients this resulted in immediate improvement in hemodynamics. These patients subsequently weaned off ventilatory support and they were discharged from the hospital. In 4 other patients, pulmonary vasodilator therapy with prostaglandin E1 and amrinone had failed and they were treated with inhaled nitric oxide (NO). In all patients, inhalation of NO resulted in immediate decrease in pulmonary pressure without significant change in systemic arterial pressure. Two patients successfully weaned from the ventilator, whereas in 2 patients decrease in pulmonary pressure was transient. They developed airway bleeding and died as a result of respiratory insufficiency. Although inhaled NO effectively reduced pulmonary pressure in patients with PHC, this effect was not maintained over 12 hours in patients associated with bronchopulmonary dysplasia. In patients at risk for severe PHC, rapid treatment with NO inhalation after initial event as well as the prevention of lung injury caused by mechanical ventilation were found to be important in the postoperative management.

Administration, Inhalation↗
PubMed1995

Rapid identification of Streptococcus pneumoniae by PCR amplification of ribosomal DNA spacer region.

Streptococcus pneumoniae is one of the important human pathogens in clinical microbiology. A polymerase chain reaction assay was designed to detect and identify S. pneumoniae through amplification of the ribosomal DNA spacer regions between the pneumococcal 16S-23S ribosomal RNA genes. Thirty-two Streptococcus and non-Streptococcus strains were tested to verify the specificity of the assay, and only S. pneumoniae strains gave a positive reaction. This method is a powerful technique for the rapid identification of S. pneumoniae.

Bacteriological Techniques↗