• Journal of Chest Surgery
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• v.36 no.2
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• pp.73-78
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• 2003

The Fontan operation has undergone a number of major modifications and clinical results have been improving over time. Nevertheless, during the follow-up period, life-threatening complications develop and affect the long-term outcomes. Surgical interventions for these complications are needed and are increasing. Material and Method: From April 1988 to January 2000, 16 patients underwent reoperations for complications after Fontan operation. The mean age at reoperation was 8.8 :-5.5 years. Initial Fontan operations were atriopulmonary connections in 8 and total cavopulmonary connections in 8. Total cavopulmonary connections were accomplished with intracardiac lateral tunnel in 5 and extracardiac epicardial lateral tunnel in 3. Five patients had variable sized fenestrations. The reasons for reoperations included residual shunt in 6, pulmonary venous obstruction in 3, atrial flutter in 3, atrioventricular valve regurgitation in 2, Fontan pathway stenosis in 1, and protein-losing enteropathy in 1 Result: There were 3 early and late deaths respectively Patients who had residual shunts underwent primary closure of shunt site (n=2), atrial reseptation for separation between systemic and pulmonary vein (n=2), conversion to lateral tunnel (n=1), and conversion to one and a half ventricular repair (n=1). Four patients who had stenotic lesion of pulmonary vein or Fontan pathway underwent widening of the lesion (n=3) and left pneumonectomy (n=1) In cases of atrial flutter, conversion to lateral tunnel after revision of atriopulmonary connections was performed (n=3). For the atrioventricular valve regurgitation (n=2), we performed a replacement with mechanical valve. In one patient who had developed protein-losing enteropathy, aorto-pulmonary collateral arteries were obliterated via thoracotomy. Cryoablation was performed concomitantly in 4 patients as an additional treatment modality of atrial arrhythmia. Conclusion: Complications after Fontan operation are difficult to manage and have a considerable morbidity and mortality. However, more accurate understanding of Fontan physiology and technical advancement increased the possibility of treatment for such complications as well as Fontan operation itself. Appropriate surgical treatment for these patients relieved the symptoms and improved the functional class, Although the results were not satisfactory enough in all patients.

• Proceedings of the Korean Institute of Electrical and Electronic Material Engineers Conference
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• 2008.06a
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• pp.181-181
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• 2008

DLC (Diamond-like Carbon) 박막은 높은 내마모성과 낮은 마찰 계수, 화학적 안정성 및 적외선 영역에서의 높은 투과율과 낮은 광 반사도, 높은 전기저항과 낮은 유전율, 전계방출특성 등 여러 가지 장점을 가진 물질이다[1]. 최근에는 DLC 박막의 여러 장점들과 산과 염기 유기용매에 대한 화학적 안정성으로 인하여 인조관절에서 인공심장의 판막에 이르기까지 의공학 관련 부품소재로 응용되고 있으며 내구성과 안정성에 있어서 탁월한 성능을 보여주고 있다. 또한 DLC 박막의 높은 경도와 낮은 마찰 계수, 부드러운 박막 표면 (수nm의 RMS 거칠기)의 장점을 살려 마그네틱 미디어와 하드디스크의 슬라이딩 표면에 사용되어지고, MEMS (Micro-Electro Mechanical System) 소자와 MMAs (Moving Mechanical Assemblies)의 고체윤활코팅으로 활용하여 미세기계의 내구성과 성능 향상을 도모할 수 있다. 이와 같이 DLC 박막은 다양한 분야에 응용되고 있으며, 박막이 지닌 여러 가지 장점들로 인하여 더 많은 분야에 응용될 가능성을 지닌 물질이다. 그러나 수 ${\mu}m$이상의 두께에서 박막이 높은 잔류응력 (residual stress)을 가지고, 열에 취약하여 이의 개선에 관한 연구들이 진행되어 지고 있다 [2]. 따라서 사용되는 목적에 따라 용도에 맞는 양질의 DLC 박막을 합성하기 위해선 합성 장치의 개발과 다양한 실험을 통한 최적의 합성조건 도출 등의 노력이 요구된다. 또한 DLC 박막 합성시의 여러 가지 증착 방법에 따른 박막 물성에 대한 재현성 확보 및 박막 증착에 관한 명확한 메커니즘 규명이 아직까지는 불분명하여 이에 관한 연구가 시급하다. 따라서 본 연구에서는 MEMS 소자와 MMAs의 고체윤활코팅으로 사용가능한 DLC 박막을 RF PECVD (Plasma Enhanced Vapor Deposition) 방식으로 합성하고 후열처리 온도에 따른 DLC 박막의 마찰계수 변화를 박막에 훼손을 주지 않는 FFM (Friction Force Microscopy) 방식을 사용하여 분석하였다.

• Journal of Biosystems Engineering
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• v.32 no.4
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• pp.263-268
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• 2007

An auto sampling and filtering unit was developed for monitoring automation of a fermentation process and its performance was evaluated. The automatic sampling and filtering unit was constructed with a glass filter, a diaphragm suction pump, and a flow direction change valve. To evaluate operating stability, delivery volumes of the suction pump were measured according to the experimental conditions of cellulose powder, pore size of the glass filter and suction head of the pump. The developed unit could deliver the sample solution under any experimental conditions except the filter pore size of $16{\mu}m$ and the suction head of 20cm. In case of the suction head of 30cm, the pump could not deliver the sample solution at all. Concentrations of the sample solutions were converged on those of the standard glucose solution after 8 minutes from the initial sampling time. The relative error of concentration between the sample and the standard solution showed 3.8, 4.8, 7.0% for the 1, 3, 5% contents of cellulose powder, respectively.

• Journal of the Korean Society of Radiology
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• v.85 no.2
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• pp.308-326
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• 2024

A comprehensive evaluation of cardiac function includes information in relation to cardiac output and systemic venous return. The heart is composed of four chambers: two atria and two ventricles, each with its own unique mechanical function. These four cardiac chambers, their valves, and the pulmonary circulation system are inter-related as they preload or afterload on each other. Cardiac dysfunction is a failure of global cardiac function, resulting in typical clinical manifestations. To investigate the underlying cause of cardiac dysfunction, a step-by-step evaluation of cardiac blood flow tracks is necessary. In this context, imaging markers showing details of the cardiac structures have an important role in assessing cardiac function. An image-based evaluation allows for investigation of function in terms of individual cardiac components. Evaluation of cardiac function using cardiac CT has recently been validated. This review aimed to discuss cardiac CT-based imaging markers for comprehensive and detailed cardiac function assessment.

• Journal of Chest Surgery
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• v.42 no.2
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• pp.148-156
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• 2009

Background: As cardiovascular operations become more complex and sophisticated, there is an increasing need for various bioprostheses for use as components of blood vessels and heart valves. We developed a fatigue stimuli test instrument to objectively evaluate the mechanical durability of a bioprosthesis, and we tested several currently known processing methods for bovine pericardium and we then compared the results. Material and Method: Fresh bovine pericardium was collected at the butcher shop with using aseptic technique, and each piece of pericardium was fixated and/or decellularized by 16 representative methods. We measured the permeability and compliance of the processed bovine pericardium samples, and measured them again after exposure to the fatigue stimuli. All the pieces of pericardium underwent microscopic examinations before and after the fatigue stimuli. Result: A mixture of glutaraldehyde and solvent treatment showed better mechanical durability than did the single glutaraldehyde treatment. High concentration glutaraldehyde treatment showed equal or no worse results than did low concentration glutaraldehyde treatment. After SDS (sodium dodecylsulfate) decellularization, the mechanical property of the bioprosthesis became much worse ($20{\sim}190$ times) and the mechanical durability to the fatigue stimuli was also very poor. Conclusion: We obtained the basic durability data after various fixation methods with using a home-made fatigue test instrument.

• Journal of Chest Surgery
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• v.43 no.1
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• pp.1-10
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• 2010

Background: Bioprosthetic materials have been made using glutaraldehyde fixation of porcine or bovine pericardium during cardiovascular surgery. But these bioprostheses have the problems of calcification and mechanical failure. We determined changes in tensile strength and elasticity of pericardium after glutaraldehyde, solvent, decellularization and detoxification. Material and Method: Tissues were allocated to four groups: glutaraldehyde with and without solvent, decellularization, and detoxification. We studied tensile strength and strain on tissues. We measured the tensile strength of fresh pericardium stretched in six directions (with 5 mm width), and % strain, which we calculated from the breaking point when we pulled the pericardium in two directions. Result: Tensile strength was reduced when we used the usual concentrated glutaraldehyde fixation (n=83, $MPa=11.47{\pm}5.40$, p=0.006), but there was no change when we used solvent. Elasticity was increased after glutaraldehyde fixation (n=83, strain $(%)=24.55{\pm}9.81$, p=0.00), but there was no change after solvent. After decellularization of pericardium, the tensile strength was generally reduced. The decrease in tensile strength after concentrated glutaraldehyde fixation for a long time was significantly greater less than after concentrated solvent (p=0.01, p=0.00). After detoxification, the differences in strength and strain were not significant. Conclusion: After glutaraldehyde treatment of pericardium there is no loss in tensile strength (even though we did the glutaraldehyde, solvent and detoxification treatments LOGIC IS UNCLEAR). Also, these treatments had a tendency to increase elasticity. Although post-treatment decellularization led to a significant loss in strength, this effect could be attenuated using a low concentration of solvent or hypertonic solution.

• Journal of Chest Surgery
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• v.29 no.11
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• pp.1218-1222
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• 1996

The reported incidence of postcardiotomy cardiogenic shock not responding to conventional therapy is still 0.1 to 0.8%. For this group of patients, more aggressive form of circulatory support must be employed. Centrifugal pumps are a ventricular assist device most commonly used on this purpose, due to low cost and easy availability. Currently, however, clinical experience of centrifugal pumps as a ventricular assist device is rarely reported in Korea. From January 1992 to January 1996, 2986 patients underwent cardiac operations on cardiopulmonary bypass at Seoul National University Hospital. Refractory postcardiotomy cardiac failure requring ventricular support with a Biomedicus centrifugal pump developed in ten of these patients. There were eight men and two women, ranged in age from nine years to 77 years with a mean of 50$\pm$20 years. The primary surgical procedures consisted of isolated coronary revascularization in four patients, combined coronary revascularization and aortic valve replacement in two, aortic dissection repair in two, pulmonary embolectomy in one, and heart transplantation in one. Of the ten patients, five had left ventricular assistance, one had right ventricular assistance, and four had biventricular assistance. Duration of ventricular assistance ranged from 24 to 175 hours, with a mean of 76$\pm$51 hours. Seven patients were weaned from ventricular assistance, and four of them discharged. The causes of death for nonsurvivors were progressive cardiac failure in two patients and multiorgan failure, intractable ventricular fibrillation, irreversible brain injury, and mechanical problem, respectively, in the other four. Survival was not predicted by time on cardiopulmonary bypass, aortic cross-clamp time, or duration of ventricular support. Major complications included bleeding(7), renal failure(6), infection(3) and neurologic complication(2). These results indicate that a centrifugal pump can provide reasonably satisfactory short-term circulatory support.