• Journal of Cardiovascular Imaging
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• 제30권4호
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• pp.263-275
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• 2022

BACKGROUND: Cardiac allograft vasculopathy (CAV) is a complication beyond the first-year post-heart transplantation (HTx). We aimed to test the utility of cardiac magnetic resonance (CMR) to detect functional/structural changes in HTx recipients with CAV. METHODS: Seventy-seven prospectively recruited HTx recipients beyond the first-year post-HTx and 18 healthy controls underwent CMR, including cine imaging of ventricular function and T1- and T2-mapping to assess myocardial tissue changes. Data analysis included quantification of global cardiac function and regional T2, T1 and extracellular volume based on the 16-segment model. International Society for Heart and Lung Transplantation criteria was used to adjudicate CAV grade (0-3) based on coronary angiography. RESULTS: The majority of HTx recipients (73%) presented with CAV (1: n = 42, 2/3: n = 14, 0: n = 21). Global and segmental T2 (49.5 ± 3.4 ms vs 50.6 ± 3.4 ms, p < 0.001;16/16 segments) were significantly elevated in CAV-0 compared to controls. When comparing CAV-2/3 to CAV-1, global and segmental T2 were significantly increased (53.6 ± 3.2 ms vs. 50.6 ± 2.9 ms, p < 0.001; 16/16 segments) and left ventricular ejection fraction was significantly decreased (54 ± 9% vs. 59 ± 9%, p < 0.05). No global, structural, or functional differences were seen between CAV-0 and CAV-1. CONCLUSIONS: Transplanted hearts display functional and structural alteration compared to native hearts, even in those without evidence of macrovasculopathy (CAV-0). In addition, CMR tissue parameters were sensitive to changes in CAV-1 vs. 2/3 (mild vs. moderate/severe). Further studies are warranted to evaluate the diagnostic value of CMR for the detection and classification of CAV.

• 재활치료과학
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• 제13권3호
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• pp.85-100
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• 2024

목적 : 사례연구를 통해 심장이식 수술 후 연하장애가 발생한 환자의 증상을 알아보고 작업치료실에서 적용한 연하장애 재활치료의 효과에 대해 알아보고자 하였다. 연구방법 : 심장 이식 수술 후 연하장애가 발생한 환자 1명을 대상으로 비디오 투시 연하검사를 통해 기능적 연하장애 척도와 침습-흡인 척도, 삼킴 곤란 결과 및 증증도 척도를 2주 간격으로 총 3회 실시하였다. 치료 기간은 2023년 7월 19일부터 8월 21일까지 회기당 30분씩 총 8회 실시하였다. 후두 상승과 상부식도조임근의 충분한 열림 및 잔여물의 감소를 위한 교정적 치료(혀-유지 기법, 저항성 턱 당기기 운동, 멘델슨 기법, 노력 삼킴, 호흠근육 운동)와 기도보호를 위한 보상적 치료(턱 당기기 자세, 여러 번 삼키기, 음식 양과 점도 변경) 및 보호자 교육을 실시하였다. 결과 : 기능적 연하장애 척도 검사의 점수가 50점에서 30점으로 감소하였으며, 침습-흡인 척도의 단계는 5단계에서 3단계로 향상되었다. 삼킴 곤란 결과 및 중증도 척도에서는 2단계에서 4단계로 향상되었다. 결론 : 심장 이식 수술 후 연하장애를 보이는 경우 연하재활치료가 환자의 삼킴 기능 향상에 도움을 주는 것을 확인하였다. 향후 심장 이식 수술 환자의 연하장애 재활치료의 효과에 대한 보완 연구가 필요할 것이다.

• Journal of Chest Surgery
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• 제39권9호
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• pp.714-717
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• 2006

심장과 신장의 경우 현대의학에서 이식이 중요한 치료방법으로 자리잡고 있으며 그 적응증이 확대되고 있다. 그러나 만성신부전은 심장이식의 금기였으며, 심부전도 신장이식의 금기로 심장과 신장의 동시이식이 이루어지는 경우는 흔치 않았다. 하지만 심부전과 신부전에 대한 치료의 발달로 심장-신장 동시이식의 필요성은 증가하고 있으며 동시에 면역학의 발달과 수술 기술 등의 발달로 그 가능성은 높아지고 있다. 우리나라에서는 지난 1969년과 1992년에 신장이식과 심장이식이 각각 성공하였으나 그동안 동시이식은 없었다. 본 증례는 분만 후 발생한 심근병증으로 심부전이 발생하고 이로 인한 신부전으로 투석을 받던 33세의 여자환자에 대해 본원에서 1년 전 시행한 '심장-신장 동시이식'에 대한 보고이다. 현재 환자는 정상 심장기능에 투석 없이 건강하게 생활하고 있으며 이에 그 결과를 문헌 고찰과 더불어 증례 보고하는 바이다.

• Journal of Chest Surgery
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• 제30권5호
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• pp.537-539
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• 1997

40세된 한 여호와의 증인 환자에게 혈액제제의 사용없이 심장이식이 성공적으로 실시되었다. 환자는 수술 전 심방세동을 보여 항응고제를 사용중이었는데 프로트롬빈치가 Hm기준으로 2.4의 상태에서 수술을 시행하였다. 이 환자의 수술후 총 출혈양은 860cc 였으며 최소 헤모글로빈치는 12.2gm/이전로 수술전의 13.8 glen에 비해 불과 1.6 gm/이밖에 감소 하지 않았다. 환자는 수술후 12시간 만에 호흡기를 제거할 수 있었으며 수술후 5개월이 지난 현재까지 경과는 매우 양호한 상태이다. 본 환자에 있어서 성공적인 무혈 수술의 원인은 여러 가지가 있겠지만 이중 cell saver의 사용, 정맥내 aprotinin의 처치, 그리고 수술중 지혈의 세밀함이 중요한 요소라고 본다.

• 한국임상수의학회지
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• 제18권4호
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• pp.358-362
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• 2001

Brain dead (BD) patients remain the largest source of solid organs for transplantation. BD has shown to decrease graft function and survival in rodent models. The aim of this study was to evaluate how brain death affects graft viability in the donor and kidney tolerance to cold preservation as assessed by survival in a canine transplantation. 13 Beagle dogs were used for the study. Brain death was induced by the sudden inflation of a subdural balloon catheter with continuous monitoring of arterial blood pressure and eletroencephalographic activity (n=3). Sixteen hours after conformation of brain death, kidney graft were retrieved (n=6). Non-BD donors served as controls (n=4). All kidneys were flushed with University of Wisconsin (UW) solution and preserved for 24 hours at 4$^{\circ}C$ before transplantation. Recipient survival rates, serum creatinine level were analyzed. Brain death induced the well-known Cushing reaction with a severe increase in blood pressure and tachycardia. Thereafter, cardiac function returned progressively to baseline within 8 hours and remained stable until the end of the experiment. All of dogs in both group transplanted were survived until 7 days (100%), and the kidneys showed functional early rejection at 8.3$\pm$0.5 days and 8.5$\pm$0.5 days after transplantation, in BD and allograft group, respectively. BD kidneys were functionally similar to control kidneys for 7 days after transplantated. Brain death has no deleterious effect on preservation injury and survival of dog kidney transplantation, although it induces changes in hemodynamic parameters. This study reveals that kidneys from BD donors do not exhibit more ischemia reperfusion injury, and support good early function and survival.

• Molecules and Cells
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• 제46권11호
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• pp.688-699
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• 2023

We set up this study to understand the underlying mechanisms of reduced ceramides on immune cells in acute rejection (AR). The concentrations of ceramides and sphingomyelins were measured in the sera from hepatic transplant patients, skin graft mice and hepatocyte transplant mice by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). Serum concentrations of C24 ceramide, C24:1 ceramide, C16:0 sphingomyelin, and C18:1 sphingomyelin were lower in liver transplantation (LT) recipients with than without AR. Comparisons with the results of LT patients with infection and cardiac transplant patients with cardiac allograft vasculopathy in humans and in mouse skin graft and hepatocyte transplant models suggested that the reduced C24 and C24:1 ceramides were specifically involved in AR. A ceramide synthase inhibitor, fumonisin B₁ exacerbated allogeneic immune responses in vitro and in vivo, and reduced tolerogenic dendritic cells (tDCs), while increased P3-like plasmacytoid DCs (pDCs) in the draining lymph nodes from allogeneic skin graft mice. The results of mixed lymphocyte reactions with ceranib-2, an inhibitor of ceramidase, and C24 ceramide also support that increasing ceramide concentrations could benefit transplant recipients with AR. The results suggest increasing ceramides as novel therapeutic target for AR, where reduced ceramides were associated with the changes in DC subsets, in particular tDCs.

• Archives of Reconstructive Microsurgery
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• 제23권2호
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• pp.89-92
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• 2014

An 8-year-old girl diagnosed with dilated cardiomyopathy and Russell-Silver syndrome was admitted to our pediatric intensive care unit due to low cardiac output and multiple-organ dysfunction. The patient was placed on the heart transplant waiting list and extracorporeal membrane oxygenation was performed as a bridge to transplantation. After 17 days, heart transplantation was performed. The donor was a 46-year-old female (weight, 50 kg; height, 150 cm). The donor:recipient weight ratio was 3.37:1. Because the dimension and volume of the recipient's thoracic cage were insufficient, the sternum could not be closed. Nine days after transplantation, the patient underwent delayed sternal closure. To obtain adequate space, we left the sternum 4.5 cm apart from each margin using four transverse titanium plates. A transverse rectus abdominis musculocutaneous flap was chosen to cover the wound. Due to the shortage of donors, a size-mismatched pediatric heart transplantation is sometimes unavoidable. Closure of the opened sternum of a transplant recipient can be challenging. Sternal reconstruction after an extremely oversized heart transplantation with transverse titanium plate fixation and a musculocutaneous flap can effectively achieve sternal closure and stability.

• 임상간호연구
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• 제19권3호
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• pp.395-406
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• 2013

Purpose: This study was aimed to investigate the relationship between the level of stress and the quality of life among the adult recipients of living donor liver transplantation. Methods: Participants were 213 outpatients who received living donor liver transplantation at least 3 months prior to this study. Stress was measured using a modified version of the Kidney Transplant Recipient Stressor Scale (KTRSS), and the quality of life was measured using SF-36 version 2. Results: The mean of scaled stress level and quality of life of liver transplant recipients were $2.44{\pm}0.13$, $69.28{\pm}18.25$, respectively. There was an inverse correlation between those two parameters. Therefore lower stress could improve quality of life. Conclusion: For the liver transplantation recipients, improving the quality of life is to be the ultimate goal of health-related mediation. Liver transplantation recipients would need to cultivate self-care ability to manage stress, and improving their quality of life.

• Journal of Chest Surgery
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• 제48권1호
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• pp.55-58
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• 2015

Although heart transplantation is a final therapeutic option in pediatric patients with dilated cardiomyopathy (DCMP), the shortage of pediatric heart donors is a major obstacle. In adults with DCMP characterized by cardiac dyssynchrony, cardiac resynchronization therapy (CRT) is known to be an effective treatment option. However, there is a lack of evidence on the effectiveness of CRT in infants with DCMP. Several studies have reported improvement in hemodynamics and cardiac performance following CRT in infants with DCMP. Here, we report CRT in an infant with DCMP during extracorporeal membrane oxygenation with 5 months of follow-up.

• Journal of Chest Surgery
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• 제46권6호
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• pp.426-432
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• 2013

Background: Heart transplantation has become a widely accepted surgical option for end-stage heart failure in Korea since its first success in 1992. We reviewed early postoperative complications and mortality in 239 patients who underwent heart transplantation using bicaval technique in Asan Medical Center. Methods: Between January 1999 and December 2011, a total of 247 patients aged over 17 received heart transplantation using bicaval technique in Asan Medical Center. After excluding four patients with concomitant kidney transplantation and four with heart-lung transplantation, 239 patients were enrolled in this study. We evaluated their early postoperative complications and mortality. Postoperative complications included primary graft failure, cerebrovascular accident, mediastinal bleeding, renal failure, low cardiac output syndrome requiring intra-aortic balloon pump or extracorporeal membrane oxygenation insertion, pericardial effusion, and inguinal lymphocele. Follow-up was 100% complete with a mean follow-up duration of $58.4{\pm}43.6$ months. Results: Early death occurred in three patients (1.3%). The most common complications were pericardial effusion (61.5%) followed by arrhythmia (41.8%) and mediastinal bleeding (8.4%). Among the patients complicated with pericardial effusion, only 13 (5.4%) required window operation. The incidence of other significant complications was less than 5%: stroke (1.3%), low cardiac output syndrome (2.5%), renal failure requiring renal replacement (3.8%), sternal wound infection (2.0%), and inguinal lymphocele (4.6%). Most of complications did not result in the extended length of hospital stay except mediastinal bleeding (p=0.034). Conclusion: Heart transplantation is a widely accepted option of surgical treatment for end-stage heart failure with good early outcomes and relatively low catastrophic complications.