Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Changes in the Luminal Surface of the PTFE Graft used in Systemic- pulmonary Shunt Operation

체폐단락술에 사용되었던 PTFE 인조혈관 내면의 변화

  • Park, Yeong-Hwan (Yonsei Univ. College of Medicine, Yonsei Cardiovascular Center, Dept. of Thoracic and Cardiovascular Surgery) ;
  • Jang, Byeong-Cheol (Yonsei Univ. College of Medicine, Yonsei Cardiovascular Center, Dept. of Thoracic and Cardiovascular Surgery) ;
  • Sin, Dong-Hwan (Yonsei Univ. College of Medicine, Dept. of Pathology) ;
  • Jo, Beom-Gu (Yonsei Univ. College of Medicine, Yonsei Cardiovascular Center, Dept. of Thoracic and Cardiovascular Surgery)
  • 박영환 (연세대학교 의과대학 심장혈관센타, 흉부외과) ;
  • 장병철 (연세대학교 의과대학 심장혈관센타, 흉부외과) ;
  • 신동환 ;
  • 조범구 (연세대학교 의과대학 심장혈관센타, 흉부외과)
  • Published : 1996.08.01
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Abstract

Histologic, and scanning electron microscopic observa ions were made of 12 biopsy specimens from polytetrdiluoroethylene (PTFE) grafts that had been Implanted as systemic-pulmonAry shunt for improving oxygenation of cyanotic congenital heart disease and harvested near the end of pulmonary artery side at the time of redo shunt or tonal correction between 1985 and 1992. The types of shunt operation are modified Blalock-Taussig shunt in 10 cases, Waterston-Cooley shunt in 1 And Potts shunt in 1 case. The 5 mm PTFE graft was used In 10, 4mm in 1 and 6mm in 1 case. The mean duration of implantalion was 0 $\pm$ 14.1 months(rl.on 12 months to 55 months). The plAtelets were aggregated between gaps'of Coretex surface and intimal thickening was noted about 10 to 20 months after implantation. Endothelial cells were found in the 40-months patent PTFE graft by light and scanning electron microscopy. In the specimen of poor flow or zero flow graft, severe intimal hyperplasia and thrombi which was made of platelets were noted . Based on this experience, we think that the patency will be maintained well if the connective tissue could be Hxed firmly over the Inner layer of the Goretex and the endothelial cell layer sllould form over the con- nective tissue and platelet aggregation should be prevented.

본 연세대학교 의과대학 흉부외과학 교실에서는 1985년 부터 1992년까지 청색성 선천성 심장기형환자에서 시행한 체 폐동맥 단락술에 사용되 었던 PTFE (polytetrafluoroethylene) 인조 혈관을 재수술시 절 제하여 꽝학 현미경 및 전자 현미경으로 관찰하였다. 체폐 동맥 단락술의 종류는 Blalock-Taussig형 10 례. Waterstone-Cooley형 1례, Pott 형 1례등이었다. 사용된 PTFE 인조 혈관의 크기는 5mm가 10개, 4mm가 1개, 6mm가 1개였다 이들의 평균 사용 시간은 31개월(12개월에서 55개월)이었다. 10개월에서 20개월사이의 PTFE 인조 혈관은 틈새에 매우 많은 혈소판이 끼어 있었고 내막 비후가 관찰되었다. 40 개월이상 기능을 하는 PTFE 인조 혈관에서는 혈관 내피 세포가 광학 및 전자 현미경으로 관찰되었다. 막힌 PTFE 인조 혈관의 내면은 매우 심한 내막 비후와 혈전으로 차 있었다. 이와 같은 우리의 경험을 토대로 PTFE인조 혈관과 자신의 혈관이 연결되는 부위에 결체조직이 잘붙어 혈관내피세포가 덮을수 있게 된다면 혈소판의 응집을 막아 오랫동안 기능을 유지할 수 있을 것으로 생각된다.

Keywords

References

  1. Surgery v.74 A new Vascular prosthesis for a small-caliber artery Matsumoto,H.;Hasegawa,T.;Fuse,K.(et al.)
  2. Ann Surg v.182 A small arterial substitute: Expanded microporous polytetrafluoroethylene: Patency vs porosity Campbell,C.D.;Goldfarb,D.;Rodney,R.
  3. Adv Surg v.111 Small-vessel replacement with Gore-Tex(expanded polytetrafluoroethylene) Florian,A.;Cohn,L.H.;Dammin,G.J.(et al.)
  4. Arch Pathol Lab Med v.109 Surface healing and histologic maturation of patent polytetrafluoroethylene grafts implanted in patients for up to 60 months Camilleri,J.P.;Phat,V.N.;Bruneval,P.(et al.)
  5. Am J Pathol v.114 Monoclonal antibodies to human intermediate filament proteins. II. Distribution of filament proteins in normal human tissues Gown,A.M.;Vogel,A.M.
  6. J Cell Biol v.95 Immunolocalization of von Willebrand protein in Weibel-Palade bodies of human endothelial cells Wagner,D.D.;Olmsted,J.B.;Marder,U.J.
  7. J Vasc Surg v.4 An experimental study of eight current arterial prosthesis Mathisen,S.R.;Wu,H.D.;Sauvage,L.R.;Usui,Y.;Walker,M.W.
  8. Arch Surg v.97 Origin of arterial prosthesis lining from circulating blood cells Mackenzie,J.R.;Hackett,M.;Topuzlu,C.;Tibbs,D.J.
  9. Vascular surgery Vascular grafts-an overview Kempczinski,R.F.;Rutherford,R.B.(ed.)
  10. Surgery v.86 Intimal hyperplasia as a complication of the use of the polytetrafluoroenthylene graft for femoral-popliteal bypass Echave,V.;Koornick,A.R.;Haimov,M.;Jacobson,J.H.
  11. Vascular surgery Graft thrombosis and thromboembolic complications Rutherford,R.B.;Nishikimi,N.;Rutherford,R.B.(ed.)
  12. Surgery v.72 Intimal and neointimal fibrous proliferation causing failure of arterial recomstructions Imparato,A.M.;Bracco,A.;Kim,G.E.
  13. Am J Pathol v.118 Mechanism of arterial graft failure Clowes,A.W.;Gown,A.M.;Hanson,S.R.;Reidy,M.A.
  14. Surg Forum v.27 Mismatch of mechanical properties as a case of arterial prosthesis thrombosis Clarke,R.E.;Apostolou,S.;Kardos,J.L.
  15. Surg Forum v.27 Effect of steroids and immunosuppression on anastomotic intimal hyperplasia in femoral arterial bypass grafts Hoepp,L.;DeWeese,J.;Elbadawi,A.
  16. Surgery v.84 A single-staged technique for seeding vascular grafts with autogenous endothelium Herring,M.;Gardner,A.;Glover,J.
  17. J Vasc Surg v.2 Endothelium develops on seeded human arterial prostheses: a brief clinical note Herring,M.;Baughman,S.;Glover,J.
  18. Arch Surg v.114 The expanded polytetrafluoroethylene graft Haimov,H,;Giron,F.;Jacobson,J.H.
  19. Surgery v.84 Prevention of platelet aggregation and adherence to prosthetic vascular grafts by aspirin and dipyridamole Oblath,R.W.;Buckley,F.O.Jr;Green,R.M.