• Journal of Cardiovascular Imaging
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• 제31권2호
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• pp.98-104
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• 2023

BACKGROUND: We aimed to investigate left ventricular (LV) global longitudinal strain (GLS) in end-stage renal disease patients and its change after kidney transplantation (KT). METHODS: We retrospectively reviewed patients who underwent KT between 2007 and 2018 at two tertiary centers. We analyzed 488 patients (median age, 53 years; 58% male) who had obtained echocardiography both before and within 3 years after KT. Conventional echocardiography and LV GLS assessed by two-dimensional speckle-tracking echocardiography were comprehensively analyzed. Patients were classified into three groups according to the absolute value of pre-KT LV GLS (|LV GLS|). We compared longitudinal changes of cardiac structure and function according to pre-KT |LV GLS|. RESULTS: Correlation between pre-KT LV EF and |LV GLS| were statistically significant, but the constant was not high (r = 0.292, p < 0.001). |LV GLS| was widely distributed at corresponding LV EF, especially when the LV EF was > 50%. Patients with severely impaired pre-KT |LV GLS| had significantly larger LV dimension, LV mass index, left atrial volume index, and E/e' and lower LV EF, compared to mildly and moderately reduced pre-KT |LV GLS|. After KT, the LV EF, LV mass index, and |LV GLS| were significantly improved in three groups. Patients with severely impaired pre-KT |LV GLS| showed the most prominent improvement of LV EF and |LV GLS| after KT, compared to other groups. CONCLUSIONS: Improvements in LV structure and function after KT were observed in patients throughout the full spectrum of pre-KT |LV GLS|.

• Journal of Chest Surgery
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• 제42권2호
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• pp.135-140
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• 2009

배경: 동종이형의 심장이식 후에 나타나는 만성 거부반응은 수술 후 약 6개월이 지나 나타나며, 이로 인해 이식된 심장의 관상동맥의 동맥 경화 소견과 심장의 손상을 일으키는 혈관병증이 나타나는 바, 대혈관인 대동맥에서도 이러한 소견을 보이는 지를 확인하고자 하였다. 대상 및 방법: $200{\sim}300gm$의 백서(Spraque-Dawley Rat)에서 이소성의 동종이형의 심장이식(heterotopic heart alto-transplantation)을 Ono-Lindsey method로 시행한 후 사이클로스포린(cyclosporin A 10mg/kg/day, 종근당 제공)을 투여하여 3개월 이상 생존한 군에서 동물을 희생시킨 후 자가 상행 대동맥과 이식된 심장의 대동맥에서 각각 조직 절편을 얻어 조직 검사를 시행하여 비교하였다. 자가 상행 대동맥의 조직 검사(N=9, native ascending aorta)와 동종 이형의 이식된 심장의 대동맥(N=13, alto-transplanted aorta)의 조직 검사를 동종이형의 심장이식 후의 만성 거부 반응의 특징적인 조직 검사 소견인 1) 내막 비후(intimal thickening), 2) 중층 비후(medial hyperplasia), 3) 중층 석회화(medial calcification), 4) 중층 염증(medial inflammation), 5) 연골 화생(chondroid metaplasia)에 대하여 한 명의 병리의에 의해 대조군과 이식군에서 각각 심한 정도를 통계처리(Mann-Whitney Test, SPSS version 12.0 Windows)하여 비교하였다. 결과: 중층 비후 외(p=0.36)에 내막 비후(p<0.0001), 중층 석회화(p=0.045), 중층 염증(p<0.0001), 연골 화생(p=0.045)에 있어 이식된 심장의 대동맥에서 의미 있는 변화를 보였다. 결론: 동종 이형의 심장 이식 후에 만성 거부 반응에 의한 혈관병증(cardiac allograft vasculopathy)은 관상 동맥을 침범하여 심근의 손상을 가져오며, 이와 같은 만성 거부 반응에 의한 혈관 병증의 변화는 대혈관인 이식된 대동맥에서도 상기의 결과와 같이 나타나 대동맥에서도 만성적인 거부 반응이 진행되고 있음을 확인할 수 있었다.

• Journal of Chest Surgery
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• 제27권1호
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• pp.1-8
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• 1994

Allograft cardiac valves have been used for over 30 years to replace diseased cardiac valves, reconstruct right or left ventricular outflow tract. With increasing its requirement, the establishment of a viable bank capable of maintaining the viability of graft over a prolonged period would be desirable. The method for determining the viability of allograft by metabolic assay technique using radiolabeled aminoacids has been used recently. An experimental study was done for evaluation of viability of cardiac allograft which was preserved for 14 days at 4oC in nutrient medium[fresh preservation] by metabolism assay technique using 3H-glycine. Also, the effectiveness of low concentration antibiotic solution[CLPV] for sterilization was evaluated. The effectiveness of CLPV solution for sterilization of allograft was perfect. Pre-treatment cultured organisms were not cultured after treatment at all in every cases. The viability of allograft after sterilization was reduced to 66.4%[aortic wall], 74.7%[pulmonary wall], 76.3%[aortic valve], 67.9%[aortic wall]. And after the fresh preservation for 14 days, the viability was reduced to 14.7%, 18.5%, 17.7%, 19.0%, respectively.In conclusion, viability of allograft was reduce to 71.3[66.4-76.3]% after sterilization and 17.5[14.7-19.0]% after fresh preservation. And sterilization effect of CLPV solution was satisfactory.

• Journal of Chest Surgery
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• 제36권6호
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• pp.418-421
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• 2003

심장-폐이식은 현재 선천성 심장 질환에 의한 이차성 폐동맥 고혈압 환자에서 최종적 치료로 알려져 있다. 본 41세 남자 환자는 동맥관 개존증에 의한 이차성 페동맥 고혈압으로 진단되었으며 심도자 검사 결과 대동맥압 130/80 mean 100 mmHg, 폐동맥 130/80 mean 109 mmHg, 우심실 130/20 mmHg, 우심방 mean 20 mmHg이었고 우측 폐동맥의 직경이 7.5 cm로 심한 확장소견이 있어 심폐이식을 필요로 하였다. 장기 공여자는 24세 남자 환자로 교통사고에 의해 뇌 경막하 출혈로 타 병원에서 뇌사 판정을 받았다. 수술은 심폐 바이페스하에 동맥관 개존증을 결찰하고 심폐이식술을 시행하였다. 수술 후 1일째 호흡기를 이탈하였으며 3일째 일반 병실로 전원되었고 33일째 퇴원하였으며 41일째 시행한 심근과 폐 조직 검사 소견에서 거부 반응은 없었다.

• Hip & pelvis
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• 제34권3호
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• pp.127-139
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• 2022

There is still controversy regarding clinical outcomes following primary hip arthroplasty after solid organ transplantation (SOT). The aim of this study was to determine whether clinical outcomes after hip arthroplasty differ between previous SOT recipients and control subjects with no history of undergoing SOT. We conducted a systematic search of MEDLINE, Embase, and the Cochrane Library for studies comparing the clinical outcomes after hip arthroplasty following SOT published up to January 5, 2022. A comparison of medical and surgery-related complications, as well as the readmission rate and 90-day mortality rate between previous SOT recipients and control subjects was performed. Subgroup analyses of the SOT types, liver transplantation (LT) and kidney transplantation (KT), were also performed. Ten studies that included 3,631,861 cases of primary hip arthroplasty were included; among these, 14,996 patients had previously undergone SOT and 3,616,865 patients had not. Significantly higher incidences of cardiac complications, pneumonia, and acute kidney injury were observed in the SOT group compared with the control group. Regarding surgical complications, a higher transfusion rate was observed in the SOT group. The readmission rate and 90-day mortality rate were also significantly higher in the SOT group. A significantly higher incidence of deep vein thrombosis was observed in the KT subgroup compared with the control group. A higher risk of medical and surgical complications, as well as higher readmission and mortality rates after hip arthroplasty was observed for previous SOT recipients compared to patients with no history of SOT.

• 한국생물공학회:학술대회논문집
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• 한국생물공학회 2003년도 생물공학의 동향(XII)
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• pp.95-97
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• 2003

본 연구에서는 손상된 심근의 재생을 위하여 골수단핵세포를 SD 래트에 이식하였고 5주 후에 심근의 재생, 신생혈관의 형성과 더불어 심장의 기능이 향상되었음을 확인할 수 있었다. 골수단핵세포를 손상된 심근경색 부위에 넣어주는 것은 추가 보완 실험을 통하여 심근경색의 치료법으로서 이용될 수 있을 것이다.

• Journal of Chest Surgery
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• 제23권4호
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• pp.622-639
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• 1990

The use of aortic valve homograft has been developed since 1962 when Ross and Barratt - Boyes independently replaced a diseased aortic valve with an orthotopically inserted homograft valve. And also surgical treatment of complex congenital cardiac malformations utilizing homograft extracardiac conduit has been tried with better result than any other prosthetic material. The present study was undertaken to clarify the safety tissue viability, sterility, after following our protocol of procurement of heart, dissection of aortic and pulmonic homograft, sterilization, cryopreservation, thawing and dilution, and transplantation on experimental animal, sheep. Tissue viability of valve and great artery was assessed by tissue culture. Sterility was evaluated by bacterial and fungal culture. The method used was proven no deleterious effect on the integrity of the valve. Tissue culture of valve tissue before, and after cryopreservation process resulted that active fibroblast growth was observed from homograft sterilized with antibiotics. And culture of the transplanted homograft from sacrificed animal showed active fibroblast growth. Pathologic examination of implanted valve tissue from sacrificed sheep showed mild calcification and minor change, but there were moderate and severe calcification of wall of great arteries.

• Journal of Chest Surgery
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• 제56권6호
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• pp.394-402
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• 2023

Background: The optimal choice of valve substitute for aortic valve replacement (AVR) in pediatric patients remains a matter of debate. This study investigated the outcomes following AVR using mechanical prostheses in children. Methods: Forty-four patients younger than 15 years who underwent mechanical AVR from March 1990 through March 2023 were included. The outcomes of interest were death or transplantation, hemorrhagic or thromboembolic events, and reoperation after mechanical AVR. Adverse events included any death, transplant, aortic valve reoperation, and major thromboembolic or hemorrhagic event. Results: The median age and weight at AVR were 139 months and 32 kg, respectively. The median follow-up duration was 56 months. The most commonly used valve size was 21 mm (14 [31.8%]). There were 2 in-hospital deaths, 1 in-hospital transplant, and 1 late death. The overall survival rates at 1 and 10 years post-AVR were 92.9% and 90.0%, respectively. Aortic valve reoperation was required in 4 patients at a median of 70 months post-AVR. No major hemorrhagic or thromboembolic events occurred. The 5- and 10-year adverse event-free survival rates were 81.8% and 72.2%, respectively. In univariable analysis, younger age, longer cardiopulmonary bypass time, and smaller valve size were associated with adverse events. The cut-off values for age and prosthetic valve size to minimize the risk of adverse events were 71 months and 20 mm, respectively. Conclusion: Mechanical AVR could be performed safely in children. Younger age, longer cardiopulmonary bypass time and smaller valve size were associated with adverse events. Thromboembolic or hemorrhagic complications might rarely occur.

• Journal of Chest Surgery
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• 제21권2호
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• pp.246-253
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• 1988

An in vitro model providing with a recirculating perfusion apparatus using an isolated canine heart and its autogenous blood, which was prepared for study of myocardial protection method. This apparatus was easily used by quick connect system and maintained well heart function for about 2 hours. The Langendorff perfusion was initiated for a 10 minute period by introducing perfusate at 37` into the aorta from aortic reservoir located 100 cm above the heart. The isolated perfused working canine heart model was a left heart preparation in which oxygenated perfusion medium [at 37K] entered the cannulated left atrium at a constant flow rate [900ml/ min] under 20 mmHg overflow system and was spontaneously ejected[no electrical pacing] via an cannula against a hydrostatic pressure of 80 cm H2O. During this working period, various indices of cardiac function were measured. The cardiac functions were stable for over 2 hours with perfusion of Krebs-Henseleit solution and autologous blood[1:1] mixture in volume and maintained heart rate ]]3-122/bpm peak systolic pressure 109-113 mmHg, cardiac output 900 ml / min and left atrial mean pressure 8-9 mmHg. In this model, the efficiency of myocardia] protection could be easily measured by means of functional, enzymatic, biochemical and ultrastructural assessment. And also, we believe this model to be a useful assessment screening model of recovery state after long duration of myocardial preservation of donor heart without difficult transplantation procedures.

• Korean Circulation Journal
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• 제52권5호
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• pp.341-353
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• 2022

Cardiovascular disease (CVD) is the leading causes of morbidity and death globally. In particular, a heart failure remains a major problem that contributes to global mortality. Considerable advancements have been made in conventional pharmacological therapies and coronary intervention surgery for cardiac disorder treatment. However, more than 15% of patients continuously progress to end-stage heart failure and eventually require heart transplantation. Over the past year, numerous numbers of protocols to generate cardiomyocytes (CMCs) from human pluripotent stem cells (hPSCs) have been developed and applied in clinical settings. Number of studies have described the therapeutic effects of hPSCs in animal models and revealed the underlying repair mechanisms of cardiac regeneration. In addition, biomedical engineering technologies have improved the therapeutic potential of hPSC-derived CMCs in vivo. Recently substantial progress has been made in driving the direct differentiation of somatic cells into mature CMCs, wherein an intermediate cellular reprogramming stage can be bypassed. This review provides information on the role of hPSCs in cardiac regeneration and discusses the practical applications of hPSC-derived CMCs; furthermore, it outlines the relevance of directly reprogrammed CMCs in regenerative medicine.