Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Animal Experiments of Heart Transplantation for Complicated Congenital Heart Disease in Neonate

신생아의 복잡심장기형에서 심장이식을 위한 동물실험

  • 박영환 (연세대학교 의과대학 흉부외과학 교실, 연세 심장혈관센타) ;
  • 윤치순 (연세대학교 의과대학 흉부외과학 교실, 연세 심장혈관센타) ;
  • 정원석 (연세대학교 의과대학 흉부외과학 교실, 연세 심장혈관센타) ;
  • 김명옥 (연세대학교 의과대학 마취과학 교실, 연세 심장혈관센타) ;
  • 조범구 (연세대학교 의과대학 흉부외과학 교실, 연세 심장혈관센타)
  • Published : 1999.06.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Heart transplantation is considerated for a selected certain group of complicated congenital heart disease in neonates because corrective surgery is very difficult and has high mortality. Precise planning of transplantation is necessary to adequately fit the donor heart to the recipient. Material and Method: We have performed 4 neonatal pig heart transplantations to test the technical feasibility. Experiment 1: The transplantation was performed using the same technique as the adult heart transplantation. Experiment 2: The transplantation for hypoplastic left heart syndrome was simulated as we reconstructed the whole aortic arch with donor aorta. Experiment 3: The heart transplantation was done with radical pulmonary artery reconstruction. Experiment 4: The experiment was performed for a long term survival. Result: Preoperative planning was very important for adequate fitting. All animals could be weaned from cardiopulmonary bypass, however, two animals died due to bleeding at pulmonary artery and left atrium. Conclusion: We concluded that the neonatal heart transplantation can be applied in some complicated Further using animal model is mandatory.

배경: 복잡심장기형의 경우 완전교정술식의 높은 난이도와 사망율로 말미암아 심장이식이 고려되고 있다. 그러나 정상심장을 이식하기에 곤란한 복잡기형의 경우 수술전 자세한 계획이 매우 중요하다고 하겠다. 신생아의 복잡심장기형에서 심장이식을 고안하기위한 동물실험을 하였다. 대상 및 방법: 8마리 신생돼지를 사용하여 4차례 심장이식실험을 하였다. 실험 1: 성인에서의 심장이식과 같은 방법으로 시행하였다. 실험 2: 좌심형성부전증후군(Hypoplastic Left Heart Syndrome)의 경우를 모의실험하기 위하여 공여돈의 대동맥궁을 이용한 성형수술을 하였다. 실험 3: 폐동맥성형술을 동반한 심장이식을 하였다. 실험 4: 이식후 장기 생존을 위한 실험을 시도하였다. 결과: 신생돈에서의 심장이식수술은 큰 어려움없이 시행할 수 있었다. 실험후 인공심폐순환에서 벗어날 수 있었으나 2마리는 폐동맥연결부위와 좌심방연결부위의 출혈로 사망하였다. 결론: 이상의 실험으로 대혈관의 위치에 따라 세심한 수술계획을 한다면 거의 실행하지 못할 복잡심장기형이 없을 것으로 보이며 신생아의 경우는 특히 출혈에 대해 주의를 해야 할 것으로 생각되었다.

Keywords

References

  1. Am J Cardiol v.22 Transplantation of the heart in an infant and an adult Kantrowitz A;Haller JD;Joos H;Cerruti MM;Carstensen HE
  2. N Engl J Med v.315 Cardiac allotransplantation in newborns as therapy for hypoplastic left heart syndrome Bailey LL;Nelson-Cannarella SL;Doroshow RW
  3. J Heart Lung Transplant v.12 Heart transplantation techniques in complex congenital heart disease Bailey LL
  4. J Heart Lung Transplant v.10 The registry of the international society for heart and lung transplantation: eighth official report-1991 Kriett JM;Kaye MP
  5. Ann Surg v.208 Orthotopic transplantation during infancy as therapy for incurable congenital heart disease Bailey LL;Assaad AN;Trimm RF(et al.)
  6. J Thorac Cardiovasc Surg v.99 Orthotopic heart transplantation for complex congenital heart disease Mayer JE;Perry S;O'Brien P(et al.)
  7. Ann Thorac Surg v.52 Heart transplantation in children: an international surgery Pennington DG;Noedel N;McBride LR;Naunheim KS;Ring WS
  8. Atlas of Heart-Lung transplantation Operative procedures for infant cardiac transplantation Chiavarelli M;Gundry SR;Razzouk AJ;Bailey LL;Kapoor AS(ed.);Laks H(ed.)
  9. Ann Thorac Surg v.56 Pediatrci cardiac transplantation for congenital heart defects: surgical considerations and results Vouhe PR;Tamisier D;Le Bidois J(et al.)
  10. J Thorac Cardiovasc Surg v.102 Pediatric heart transplantation after operations involving the pulmonary arteries Cooper MM;Fuzesi L;Addonizio LJ(et al.)
  11. J Heart Transplant v.9 Pediatric heart transplantation: surgical considerations for congenital heart diseases Chartrand C;Guerin R;Kangah M;Stanley P
  12. Ann Thorac Surg v.52 Expanding applicability of transplantation after multiple prior palliative procedures Menkis AH;McKenzi FN;Novick RJ(et al.)
  13. J Heart Transplant v.9 Special considerations for heart transplantation in congenital heart disease Menkis AH;McKenzie FN;Novick RJ(et al.)
  14. J Heart Lung Transplant v.10 Oversizing of donor hearts: beneficial or detrimental? Costanzo-Nordin MR;Liac Y;Grusk BB(et al.)
  15. Ann Thorac Surg v.57 Cardiac transplantation in infants and chilren Turrentine MW;Kenneth AK;Caldwell R(et al.)
  16. J Thorac Cardiovasc Surg v.104 The effects of donor-recipient size disparity in infants and pediatric heart Fullerton DA;Gundry SR;Alonso de Begona J;Kawauchi M;Razzouk AJ;Bailey LL
  17. J Thorac Cardiovasc Surg v.105 no.5 Bless the babies; 115 late survivors of heart transplantation during the first year of life Bailey LL;Gundry SR;Razzouk AJ;Wang N;Sciolaro CM;Chiavarelli M
  18. Ann Thorac Surg v.54 Fontan procedure for hypoplastic left heart syndrome Norwood WI Jr;Jacobs ML;Murphy JD