• Journal of Chest Surgery
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• 제28권6호
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• pp.533-541
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• 1995

We recently developed a new model of moving actuator type totally implantable artificial heart[TIAH , based on the reverse position of the aortic and pulmonary conduits. This concept was proposed by one of surgeons in our team[Joon-Ryang Rho, M.D. to facilitate anatomical fitting of TIAHs. The moving actuator type electromechanical TIAH consisted of the left and right blood sacs, and the moving actuator including a motor. The inverted umbrella type polyurethane valves were used in the blood pumps. The aortic conduit was positioned anterior to the pulmonary conduit, which was the opposite relation to the conventional configuration of other total artificial hearts. We also adapted slip-in connectors for the aortic and pulmonary conduits. Two sheep , weighing 60-69 kg, were used for implantation. After small cervical incision and trans-sternal bilateral thoracotomy, cardiopulmonary bypass [CPB was administered using an American Optical 5-head pump and a membrane oxygenator[Univox-IC, Bentley . The anterior and posterior vena cavae were drained separately for venous return. An arterial return cannula was inserted into the right common carotid artery. During CPB, almost all of the ventricular myocardium was excised down to the atrioventricular groove and the artificial heart was implanted. We achieved 3-day survival in the first sheep and 2-day survival in the second. The day after operation the first sheep was successfully extubated and the second sheep was weaned from a respirator with good condition. After extubation, the first sheep walked around in the cage and fed herself. Serial laboratory and hemodynamic examinations were done during the experiments. In both sheep, pulmonary dysfunction was gradually developed, which was accompanied by acute renal failure. The animals were sacrificed and autopsy was done. Unexpected pregnnacy was incidentally found in both sheep. To our knowledge this is the first report of significant survival cases in the orthotopic implantation of electric TIAH using sheep.

• Journal of Ginseng Research
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• 제31권1호
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• pp.23-33
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• 2007

Ginsenosides are one of the most well-known traditional herbal medicines frequently used for the treatment of cardiovascular symptoms in korea. The anti-ischemic effects of the mixture of ginsenoside $Rg_3$, and CK on ischemia-induced isolated rat heart were investigated through analyses of changes in hemodynamics ; blood pressure, aortic flow, coronary flow, and cardiac output. The subjects in this study were divided into four groups: normal control, the mixture of ginsenoside $Rg_3$ and CK, an ischemia-induced group without any treatment, and an ischemia-induced group treated with the mixture of ginsenoside $Rg_3$ and CK. There were no significant differences in perfusion pressure, aortic flow, coronary flow and cardiac output between them before ischemia was induced. The supply of oxygen and buffer was stopped for five minutes to induce ischemia in isolated rat hearts, and the mixture of ginsenoside $Rg_3$ and CK was administered during ischemia induction. Treatments of the mixture of ginsenoside $Rg_3$ and CK significantly prevented decreases in perfusion pressure, aortic flow, coronary flow, and cardiac output under ischemic conditions. In addition, hemodynamics (except heart rate) of the group treated with the mixture of ginsenoside $Rg_3$ and CK significantly recovered 60 minutes after reperfusion compared to the control group (mixture+ischemia vs ischemia - average perfusion pressure: 74.4${\pm}$2.97% vs. 85.1${\pm}$3.01%, average aortic flow volume: 49.11${\pm}$2.72% vs. 59.97${\pm}$2.93%, average coronary flow volume: 58.50${\pm}$2.81% vs. 72.72${\pm}$2.99%, and average cardiac output: 52.47${\pm}$2.78% vs. 63.11${\pm}$2.76%, p<0.01, respectively). These results suggest that treatment of the mixture of ginsenoside $Rg_3$ and CK has distinct anti-ischemic effects in ex vivo model of ischemia-induced rat heart.

• Journal of Chest Surgery
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• 제31권2호
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• pp.113-117
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• 1998

아산재단 서울중앙병원 흉부외과에서는 1993년 10월부터 1997년 4월 사이에 대동맥륜대동맥 확장환자에서 37례의 Bentall술식을 시행하였다. 환자군의 술전 호흡곤란 정도는 NYHA Class I이 4례, Class II가 10례, Class III가 20례, Class IV가 3례였다. 수술은 대동맥박리증이 동반된 경우 초저체온법(식도체온: 11.8$\pm$1.6!), 완전순환정지, 역행성 대뇌관류법을 시행하였다. 37례 모두 병변이 있는 대동맥벽을 대부분 제거하고 복합이식편이나 대동맥 인조혈관 및 인공판막을 이용하여 상행대동맥과 대동맥판막을 치환하였고, 관상동맥편을 인조혈관에 직접 연결하였다. 수술결과는 합병증은 7례 발생하였으며(18%), 수술사망은 없었으나 뇌혈관 발작으로 인한 1례의 만기 사망이 있었다(2.7%). 퇴원후 추적기간은 1개월에서 36개월까지였으며 평균 9.6개월였다. 결론적으로 대동맥륜대동맥 확장의 수술에 있어 Bentall술식은 안전하고 좋은 수술이라 할 수 있다.

• 대한핵의학회지
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• 제19권2호
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• pp.43-50
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• 1985

With the improvement of hemodialysis, the course of the disease in patient with endstage renal disease has been clearly improved. Nevertheless, among several shortcomings to our present mode of renal replacement therapy, cardiovascular complications have been the leading cause of morbidity and mortality. Several factors such as anemia, arteriovenous shunting of blood, intermittent extracorporeal circulation and hypertension may be contributing. But little is known about the quantitative cardiac hemodynamic characteristics occurred during hemodialysis. The purpose of this study is to observe the sequential hemodynamic changes before, during and after the hemodialysis and to investigate reliable parameters in the detection of ventricular dysfunction. In the present study, equilibrium radionuclide cardiac angiography was performed and left and right ventricular volume indices, ejection phase indices of both ventricular, performance were measured in the 16 stable patients with chronic renal failure treated with maintenance hemodialysis sequentially i.e. before, during (early and late phase) and after the hemodialysis. The results obtained were as follows; 1) The indices of the left ventricular function were not changed during the hemodialysis but increased after the hemodialysis. 2) The indices of the right ventricular function(EF, SVI) were significantly decreased in the early phase (15, 30 minutes after starting extracorporeal circulation) but recovered after the hemodialysis. 3) The ratio of right ventricular to left ventricular ejection fraction was significantly decreased in the early phase and the lung volume indices were significantly increased at the same phase. As a conclusion, hemodialysis improves left ventricular function maybe due to increased contractility, and effects on the right ventricular function maybe due to the increased lung volume in the early phase of hemodialysis.

• Nutritional Sciences
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• 제7권4호
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• pp.214-217
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• 2004

Dietary intervention and simvastatin is beneficial in the prevention cardiovascular diseases by lowering plasma lipid levels. Endothelial dysfunction is associated with coronary artery disease and its risk factors and is reversed by dietary intervention. It has been suggested that hyperlipidemia contributes to the development of atherosclerosis by increasing inducible nitric oxide synthase (iNOS) expression via intimal thickening. Statins treatment has been found to decrease iNOS expression and atherogenensis in animal models. We hypothesized that dietary intervention and simvastatin therapy could decrease plasma nitric oxide in hypercholesterolemic patients, which would suggest the opportunity for modulation of iNOS expression through the use of statins in a clinical situation. We measured the plasma levels of nitrite and nitrate (NOx) in 19 hyperlipidemia patients. The subjects were under dietary intervention following simvastatin therapy for 12 weeks. As a result, the plasma level of NOx, stable metabolites of nitric oxide (NO), saw a two-fold elevation in hyperlipidemic patients as compared to normal levels. Although 12 weeks of dietary intervention did not lower NOx levels, subsequent 12-week simvastatin (10 mg/day) treatment, along with dietary intervention, lowered NOx levels significantly. This NOx reduction, induced by simvastatin therapy, positively correlated with lowered coronary risk factors (r=0.40, p=0.02). It indicated that simvastatin therapy decreases plasma NOx levels by, perhaps, decreasing iNOS expression or activity leading to the attenuation of the development of neointima.

• Clinical and Experimental Pediatrics
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• 제60권11호
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• pp.365-372
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• 2017

Purpose: The mechanism for the pathogenesis of adriamycin (ADR)-induced cardiomyopathy is not yet known. Different hypotheses include the production of free radicals, an interaction between ADR and nuclear components, and a disruption in cardiac-specific gene expression. Apoptosis has also been proposed as being involved in cardiac dysfunction. The purpose of this study was to determine if apoptosis might play a role in ADR-induced cardiomyopathy. Methods: Male Sprague-Dawley rats were separated into 2 groups: the control group (C group) and the experimental group (ADR 5 mg/wk for 3 weeks through intraperitoneal injections; A group). Echocardiographic images were obtained at week 3. Changes in caspase-3, B-cell leukemia/lymphoma (Bcl)-2, Bcl-2-associated X (Bax), interleukin (IL)-6, tumor necrosis $factor-{\alpha}$, brain natriuretic peptide (BNP), troponin I, collagen 1, and collagen 3 protein expression from the left ventricle tissues of C and A group rats were determined by Western blot. Results: Ascites and heart failure as well as left ventricular hypertrophy were noted in the A group. Ejection fraction and shortening fraction were significantly lower in the A group by echocardiography. The expression of caspase-3, Bax, IL-6, BNP, collagen 1, and collagen 3 were significantly higher in the A group as compared with the C group. Protein expression of Bcl-2 decreased significantly in the A group compared with the C group. Conclusion: ADR induced an upregulation of caspase-3, Bax, IL-6, and collagen, as well as a depression in Bcl-2. Thus, apoptosis and fibrosis may play an important role in ADR-induced cardiomyopathy.

• The Korean Journal of Physiology and Pharmacology
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• 제24권4호
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• pp.287-298
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• 2020

Ca²⁺ signaling of endothelial cells plays a critical role in controlling blood flow and pressure in small arteries and arterioles. As the impairment of endothelial function is closely associated with cardiovascular diseases (e.g., atherosclerosis, stroke, and hypertension), endothelial Ca²⁺ signaling mechanisms have received substantial attention. Increases in endothelial intracellular Ca²⁺ concentrations promote the synthesis and release of endothelial-derived hyperpolarizing factors (EDHFs, e.g., nitric oxide, prostacyclin, or K⁺ efflux) or directly result in endothelial-dependent hyperpolarization (EDH). These physiological alterations modulate vascular contractility and cause marked vasodilation in resistance arteries. Transient receptor potential (TRP) channels are nonselective cation channels that are present in the endothelium, vascular smooth muscle cells, or perivascular/sensory nerves. TRP channels are activated by diverse stimuli and are considered key biological apparatuses for the Ca²⁺ influx-dependent regulation of vasomotor reactivity in resistance arteries. Ca²⁺-permeable TRP channels, which are primarily found at spatially restricted microdomains in endothelial cells (e.g., myoendothelial projections), have a large unitary or binary conductance and contribute to EDHFs or EDH-induced vasodilation in concert with the activation of intermediate/small conductance Ca²⁺-sensitive K⁺ channels. It is likely that endothelial TRP channel dysfunction is related to the dysregulation of endothelial Ca²⁺ signaling and in turn gives rise to vascular-related diseases such as hypertension. Thus, investigations on the role of Ca²⁺ dynamics via TRP channels in endothelial cells are required to further comprehend how vascular tone or perfusion pressure are regulated in normal and pathophysiological conditions.

• Journal of Chest Surgery
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• 제28권12호
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• pp.1107-1112
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• 1995

Between December 1993 and December 1994, fifty-eight percent of the mitral valve patients[33/57 had undergone mitral valve repair. Their mean age was 49[SD-16 years[range 11 - 75 and they were consisted with 15 males and 18 females. The causes of mitral disease in 33 patients were classified as follows: 19 cases[58% were degenerative, 9[27% were rheumatic, 3[9% were congenital and 2[6% were infectious. Carpentier`s functional classification was consisted with Class I 4 cases[12% , II 25 [76% and III 4 [12% . Surgical techniques included prosthetic annuloplasty in 32 cases[97% , leaflet resection in 16[48% , chorda shortening in 13[39% , chorda transfer in 9[27% , new chorda formation in 7[21% , commissurotomy in 7[21% , leaflet mobilization in 4[12% , chorda resection in 3[9% , papillary muscle splitting in 2[6% , cleft repair in 2[6% , leaflet patching in 1[3% and vegetation removal in 1[3% . Average number of mitral anatomical lesions per patient was 3.3 and We used average 3.0 procedures upon mitral valve apparatus per patient. Intraoperative transesophageal echocardiography was carried out in 27 patients[82% for providing an immediate and accurate assessment of the adequacy of the reconstruction before closure of the chest. Operative mortality was absent. The mean functional class[NYHA was 2.87 preoperative and improved to 1.03 postoperatively. Postoperative Doppler echocardiography showed much improvement from grade II MR[5 , grade III[5 , grade IV[21 to no MR[26 , only trace MR[3 , grade III MR[2 . Postoperative mean mitral valve area was 2.4$\pm$0.6cm2[range 1.5 - 4.0 . We conclude that cautiously evaluated mitral valve reconstruction is stable and predictable operation with minimal postoperative left ventricular dysfunction.

• 생명과학회지
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• 제19권1호
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• pp.81-86
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• 2009

12주 유산소 트레이닝 결과, 제 2형 당뇨 대상자의 신체적 특성 및 심혈관계 기능은 향상되었고, 심근허혈을 판단하는 ST-level과 ST-slope가 트레이닝 후 감소함을 나타냈다. 또한, 당뇨에서 자주 나타나는 대표적인 자율신경계 이상 마커인 QTc interval을 감소시켰다. 따라서, 12주 유산소 트레이닝은 심혈관계 기능과 당뇨로 인한 심장허혈, 자율신경계 기능을 증진시킨 것으로 나타냈다.

• Journal of Chest Surgery
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• 제21권1호
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• pp.70-81
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• 1988

From January 1962 to March 1987, 97 patients underwent operation for mitral valve disease. Of these patients, 61 [62.9%] required mitral valve replacement. Thirty-six patients [37.1%] had mitral valve repair. The mean age was 26.9*11.6 years [range 5 months to 48 years]. There were 32 [88.9%] cases of rheumatic valve disease, 4 [11.1%] cases of congenital mitral valve disease. Valve dysfunction was classified into three types: type I [normal leaflet motion], 6 patients; type II [prolapsed leaflet], 1 patient; type III [restricted leaflet motion], 29 patients. Twenty-nine patients [80.6%] had pure or predominant stenosis and 7[19.4%] had pure regurgitation. No patient was in NYHA functional class I. Three patients [16.7%] were in functional class II, 15[83.3%] were in functional class II. The techniques used included closed mitral commissurotomy [16 patients], open mitral commissurotomy [13 patients], localized Wooler type annuloplasty [4 patients], suture repair of leaflet defect [3 patients], chordal shortening [1 patient], Carpentier ring annuloplasty [1 patient], and fenestration of fused chordae [1 patient]. There were two perioperative deaths [5.6%], related to left ventricular failure and reoperation. The survivors were followed up for 94 patient-years [mean 4.68*5.54 years]. One late death [1.1*1.1% per patient-year] occurred and was valve related. Reoperation was required in 3 patients, of whom 2 were deaths. There was 1 case [1.1*1.1% per patient-year] of thromboembolism. No patient received anticoagulant after operation. At 10 year, 92*7.4% of the patients were still alive. The actuarial survival rate of patients free of valve-related complication was 79*6.4% at 6 years, 27*12.1% at 11 years. After surgery, 18 patients [88.9%] were in NYHA functional class I or II.