• Journal of Chest Surgery
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• 제31권10호
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• pp.919-923
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• 1998

연구배경: 인체에 이식된 동종 혹은 이종조직은 궁극적으로 석회화 변성이 일어난다. 저자들은 독자적인 항석회화 처리법을 이용해 석회화에 내구성을 가진 심혈관용 조직첨포를 개발하였다. 재료 및 방법:도축장에서 채취한 신선한 소의 심막을 Hank 용액에 담아 실험실로 이송하였다. 불필요한 부분을 절제해 낸 심낭조직을 0.65% glutaraldehyde 용액(4$^{\circ}C$)에 1주일 동안 저장한 다음 phophate-buffered saline 용액(pH 7.4)로 세척하였다. 이후 2.5% 술폰산화 폴리에틸렌옥사이드(PEO-SO3) 용액으로 실온에서 2일 동안 처리한 다음 4$^{\circ}C$ NaBH4용액으로 16시간 동안 환원시켰다. 실험은 글루타르알데하이드 용액으로만 처리한 심막첨포와 항석회화 처리된 심막첨포를 각각 대조군(GA군, n=4)과 실험군(PEO-SO3군, n=4)으로 나누어 혈관벽에 이식하여 석회화 변성 정도를 비교하였다. 실험모델은 성견의 폐동맥과 대동맥 벽의 일부를 절제한 후 심막첨포로 재건하는 방법을 이용하였고, 수술 후 평균 1개월 째에 이식된 첨포를 적출하여 조직병리 변화와 칼슘 및 인 함량을 측정하였다. 결과: 실험군이 대조군에 비해 조직 위축 변성, 칼슘(폐동맥; 1.55$\pm$0.29 vs. 6.72$\pm$0.70 mg/g, 대동맥; 7.10$\pm$1.05 vs. 13.81$\pm$2.33 mg/g) 및 인의 침착량 (폐동맥; 2.58$\pm$0.40 vs. 12.60$\pm$3.40 mg/g, 대동맥; 8.11$\pm$1.07 mg/g vs. 19.33$\pm$4.31 mg/g)이 현저하게 적었다 (P<0.01). 결론:이상의 결과에서 PEO-SO$_3$로 처리한 조직첨포는, 비록 단기관찰 결과이지만, 충분한 석회화 내성을 보이며 이 조직첨포의 장기적인 안정성과 적합성에 대해서는 계속적인 연구가 필요할 것이다.

• Journal of Chest Surgery
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• 제47권4호
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• pp.333-343
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• 2014

Background: A preclinical study was conducted for evaluating a valved conduit manufactured with a glutaraldehyde (GA)-fixed bovine pericardium treated using an anticalcification protocol. Methods: Bovine pericardia were decellularized, fixed with GA in an organic solvent, and detoxified. We prepared a valved conduit using these bovine pericardia and a specially designed mold. The valved conduit was placed under in vitro circulation by using a mock circulation model, and the durability under mechanical stress was evaluated for 2 months. The valved conduit was implanted into the right ventricular outflow tract of a goat, and the hemodynamic, radiologic, histopathologic, and biochemical results were obtained for 6 months after the implantation. Results: The in vitro mock circulation demonstrated that valve motion was good and that the valved conduit had good gross and microscopic findings. The evaluation of echocardiography and cardiac catheterization demonstrated the good hemodynamic status and function of the pulmonary xenograft valve 6 months after the implantation. According to specimen radiography and a histopathologic examination, the durability of the xenografts was well preserved without calcification at 6 months after the implantation. The calcium and inorganic phosphorus concentrations of the explanted xenografts were low at 6 months after the implantation. Conclusion: This study demonstrated that our synergistic employment of multiple anticalcification therapies has promising safety and efficacy in the future clinical study.

• Journal of Chest Surgery
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• 제36권8호
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• pp.602-605
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• 2003

Norwood 시술에 있어서 체순환 혈관을 넓히는 데 동종 혈관을 이용한 방법이 많이 알려져 있으나, 동종 혈관은 숫자적으로 제한적이고 구하기 어려운 점이 있다. 본원에서는 생후 23일로 여러 부위의 좌심실 유출로 협착이 있는 남아(2.2 kg)와 생후 9일로 좌심실형성부전증 남아(3.0 kg)에서 우심낭으로 체순환 유출로 모양을 재단하여 사용하였다. 이 방법은 술식이 쉽고 재현 가능성이 높으며 동종혈관처 럼 매우 효과적이다.

• Journal of Chest Surgery
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• 제22권5호
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• pp.724-730
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• 1989

The development of severe pericardial adhesion after cardiovascular surgical procedures often increases the risk of injuring the heart, great vessels, or extracardiac grafts during resternotomy. Several pericardial substitutes have been tested in an attempt to facilitate reoperation with inconclusive results. This study was designed to evaluate the applicability of two different materials as pericardial substitutes to minimize the pericardial adhesion and epicardial reaction. A procedure for induction of pericardial adhesion was carried out in 30 rabbits. Rabbits were divided into three groups of ten rabbits each: Group 1[control, simple pericardial closure]: Group 2[bovine pericardium as pericardial substitute]: Group 3[e-polytetrafluoroethylene surgical membrane, e-PTFE as a pericardial substitute]. Bovine pericardium or e-PTFE surgical membrane was interposed between the sternum and the heart. Rabbits were sacrificed at 4 weeks after operation. The development of adhesions and epicardial reactions were graded as: none [I]; minimal[II]; moderate[Ill]; and severe[1V]. Histologic studies of the substitute, the pericardium, and the epicardium were performed. The results were as follows; l. In group 1[control group], the degree of pericardial adhesions were grade I in none, grade II in 1, grade III in 3, and grade 1V in 6 animals. Epicardial reactions were grade I in none, grade II in 3, grade K in 4, grade 1V in 3 animals respectively. 2. In group 2[bovine pericardium], the degree of pericardial adhesions were grade I in 1, grade II in 5, grade III in 3, and grade 1V in 1 animal. Epicardial reactions were grade I in 1, grade II in 2, grade III in 4, and grade 1V in 3 animals respectively. 3. In group 3[e-PTFE], the degree of pericardial adhesions were grade I in 7 animals, grade II in 2, grade III in 1, and grade g in none. Epicardial reactions were grade I in 4, grade II in 3, grade III in 2, and grade IV in 1 animal respectively. Pericardial adhesions more than grade II were 90.9% in group 1, 40 % in group 2, and 10% in group 3. Pericardial adhesions were significantly reduced in group 3 compared to group 1 or 2. Epicardial reactions more than grade II were 70 % in group 1, 70 % in group 2 and 30 % in group 3. We concluded that this 0.1mm thick polytetrafluoroethylene surgical membrane is a suitable pericardial substitute to minimize the development of pericardial adhesion or epicardial reaction following cardiovascular surgery.

• Journal of Chest Surgery
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• 제42권2호
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• pp.148-156
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• 2009

배경: 심혈관 수술이 발달함에 따라 혈관 또는 판막 등의 일부로써 사용하기 위한 보철편의 필요성이 대두되고 있다. 저자들은 보철편의 기계적 성질을 객관적으로 평가하고 내구성에 대한 정보를 얻기 위하여 피로 자극 시험 장비를 개발하였고, 다양한 방법으로 처리된 우(牛)심낭편을 시험하여 그 결과를 확인하고 서로 비교하여 더 나은 처리방법을 찾고자 하였다. 대상 및 방법: 도살장에서 신선 우심낭편을 무균 채취한 뒤 총 16가지의 대표적인 처리방법으로 우심낭편을 고정 또는 탈세포화 한 뒤 피로 실험 전후로 조직의 투과도와 유순도를 측정하여 비교하였고 또한 광학현미경을 통한 조직검사로 조직 구조의 가시적인 변화 정도를 확인하였다. 결과: 글루타르알데히드 단독으로 고정한 경우에 비해 글루타르알데히드와 용매를 혼합하여 고정한 경우가 더 좋은 기계적 내구성을 보였다. 최근 기성제품에서는 저농도 글루타르알데히드가 널리 쓰이고 있으나, 면역학적 이점이 있을 것으로 생각되는 고농도 글루타르알데히드로 고정한 우심낭편도 기계적 내구성에 문제가 얼었다. 탈세포화는 석회화 예방을 위해 다분히 필요한 과정으로 생각되고 있으나, 흔히 쓰이고 있는 SDS를 미용한 탈세포화는 우심낭편의 기계적 성질을 크게 악화시켜 투과도와 유순도가 $20{\sim}190$배 정도까지 증가하며, 탈세포화를 거친 우심낭편은 기계적 내구성도 매우 떨어져 피로 자극 후 투과도와 유순도가 크게 증가하는 것을 확인할 수 있었다. 결론: 자체 개발한 피로 자극 실험 장비를 이용하여 다양한 방법으로 처리한 심낭편의 내구성을 평가할 수 있었으며 향후 최적의 심낭편 처리방법을 개발하기 위한 기초적인 데이터를 얻을 수 있었다.

• Journal of Chest Surgery
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• 제37권4호
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• pp.307-312
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• 2004

With the development of cardiac surgical technique, we need more prosthetic materials for repairing the intra- and extracardiac defects. Although bovine pericardial bioprosthesis treated with glutaraldehyde (GA) solution is one of the most popular materials, it has a drawback of later calcific degeneration. The purpose of this study is to investigate the effectiveness of several materials and methods in reducing the calcific degeneration of bovine pericardium. Material and Method: Forty square-shaped pieces of bovine pericardia were fixed in 0.625% GA solution with 4 g/L MgCl$_2$ㆍ6$H_2O$ as a control group (group 1). Other 40 pieces pre-treated with 1 % SDS(group 2) and 40 pieces post-treated with 8% glutamate (group 3) and 2% chitosan (group 4) were also fixed in the same GA solution. Other 40 pieces pre-treated with 1% SDS and post-treated with 8% glutamate and 40 pieces post-treated with 2% chitosan were also fixed in the same GA solution (group 5, 6). The pericardial pieces were implanted into the belly of 40 Fisher 344 rats subdermally and were extracted 1 month, 2 months, 3 months, and 6 months after the implantation. With an atomic absorption spectrophotometry, we measured the calcium amount deposited and examined the tissue with microscope. Result: The calcium deposition in 1 month was less in group 2, 5, 6 than that in group 1 (p＜0.05). It was most prominent in group 5 (p＜0.01). This finding continued in 2 month. In 3 month, the calcium deposition was less in group 3 and 4 as well as group 2, 5, and 6 than in group 1. In 6 month, the calcium deposition in group 2, 3, 4, 5, and 6 was less than that in group 1 and the difference was more than that of 1, 2, and 6 month. The microscopic calcium deposition was also less in group 2 and 5. Calcium deposition developed in the whole layer of pericardium, beginning with the surrounding the collagen fiber and progressing inwardly. Conclusion: Pre-treatment with SDS, post-treatment with glutamate or chitosan, and SDS pre-treatment and post-treatment with glutamate or chitosan were effective in reducing the calcium deposition in bovine pericardium. Moreover, the combined method of SDS pre-treatment and glutamate post-treatment was more effective than other methods.

• Journal of Chest Surgery
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• 제35권2호
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• pp.133-136
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• 2002

12년 전 23mm 기계판막과 소심낭편으로 작은 대동맥륜과 심실중격 및 우심실유출로를 확장하는 Konno씨 수술을 받은 28세된 남자가 갑작스런 심부전증으로 전원되었다. 대동맥판막 상부와 하부의 대동맥과 심실 중격을 복원한 소심낭편에 천공들이 있었는데, 그 심낭편은 심하게 석회화 되고 변성되어 있었다. 그 천공들은 석회화 되고 변성되어 딱딱해진 소심낭편과 기계판막 자체의 유동성에서 생긴 균열에 의한 것으로 보였다. PTFE 이식편을 이용하여 Konno씨 수술을 다시 시행하였다.

• Journal of Chest Surgery
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• 제44권2호
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• pp.99-107
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• 2011

Background: Calcification is the most frequent cause of clinical failure of bioprosthetic tissues fabricated from GA-fixed porcine valves or bovine pericardium. A multi-factorial approach using different mechanisms was recently developed to reduce the calcification of bioprosthetic tissues. The purpose of the present study was to evaluate the synchronized synergism of using L-arginine and $NaBH_4$, compared with ethanol and L-lysine, in glutaraldehyde treated porcine pericardium from the standpoint of calcification and tissue elasticity. Materials and Methods: Porcine pericardium was fixed at 0.625% GA (7 days at room temperature after 2 days at $4^{\circ}C$). An interim step of ethanol (80%; 1 day at room temperature) or L-lysine (0.1 M; 2 days at $37^{\circ}C$) or L-arginine (0.1 M; 2 days at $37^{\circ}C$) was followed by completion of the GA fixation. A final step of NaBH4 (0.1 M; 2 days at room temperature) was followed. Their tensile strength, thickness, and thermal stability were measured. Treated pericardia were implanted subcutaneously into three-week-old Sprague-Dawley rats for 8 weeks. Calcium content was assessed by atomic absorption spectroscopy and histology. Results: L-arginine and $NaBH_4$ pretreatment ($1.81{\pm}0.39$ kgf/5 mm p=0.001, $0.30{\pm}0.08$ mm p<0.001) significantly increased tensile strength and thickness compared with the control ($0.53{\pm}0.34$ kgf/5 mm, $0.10{\pm}0.02$ mm). In a thermal stability test, L-arginine and $NaBH_4$ pretreatment ($84.25{\pm}1.12^{\circ}C$, p=0.023) caused a significant difference from the control ($86.25{\pm}0.00^{\circ}C$). L-lysine and $NaBH_4$ pretreatment ($183.8{\pm}42.6$ ug/mg, p=0.804), and L-arginine and $NaBH_4$ pretreatment ($163.3{\pm}27.5$ ug/mg, p=0.621) did not significantly inhibit calcification compared to the control ($175.5{\pm}45.3$ ug/mg), but ethanol and $NaBH_4$ pretreatment did ($38.5{\pm}37.3$ ug/mg, p=0.003). Conclusion: The combined pretreatment using L-arginine and $NaBH_4$ after GA fixation seemed to increase the tensile strength and thickness of porcine pericardium, fixed with GA. Additionally, it seemed to keep thermal stability. However it could not decrease the calcification of porcine pericardium fixed with GA. $NaBH_4$ pretreatment seemed to decrease the calcification of porcine pericardium fixed with GA, but only with ethanol.

• Journal of Chest Surgery
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• 제25권11호
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• pp.1327-1336
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• 1992

Between Jan. 1986 and Aug. 1992. 72 patients underwent Rastelli procedure. There were 43 male and 29 female, aged 46 days to 16 years [mean age, 5.2 years] with 18 patients less than 2 years of age. All patients had complex defect, 27 pulmonary atresia with ventricular septal defect, 18 corrected transposition of great arteries with pulmonary atresia or punmonary stenosis, 10 truncus arteriosus, 10 double outlet right ventricle with pulmonary atresia or stenosis, 7 complete transposition of great artersia with pulmonary atresia or pulmonary stenosis. The types of extracardiac valved conduit used were prosthetic valve[n=47, 24 car-bomedics, 19 Ionescu-Shiley, 4 Bjork-shiley] and hand-made trileaflet valve using pericardium. [n=23, 20 bovine pericardium, Z autologous pericardium, 1 equine pericardium] The mean size of valved cinduit was 5.25mm larger in diameter than the size of main pulmonary artery. [normalized to the patient`s body surface area] There were 17 hospital death[24%] and 4 late deaths[5.6%]. Postoperative complication rate was 38.9%a, none of which was conduit-related. All patients were followed pos-toperatively for 1 to 73 months. [mean 25.8 months] During follow-up period, reoperation was done in 6 patients due to stenosis of valved conduit. Mean interval between intial repair and reoperation was 20.3 months. In our experience, li recently extracardaic valved conduits between right ventricle [or pulmonary ventricle] and pulmonary artery were inserted with increasing frequency in infants less than 2 year, but hospital mortality was decreased, 2] Risk of reoperation due to conduit stenosis is low, so that the effect of graft failure on overall survival is minimized. 3] Nevertheless, because any type of extracardaic valved conduit is not ideal in children, we recommended that Lecompte should be done if cardiac anatomy is permitted.

• Journal of Chest Surgery
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• 제43권1호
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• pp.1-10
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• 2010

배경: 심장 혈관계 수술에서 인공 조직 보철편은 주로 소나 돼지 판막, 심낭의 글루타알데하이드 고정 방법을 사용하고 있으나 중장기적으로 이식편의 석회화 및 물리-기계적인 결함이 문제시 되고 있다. 이 중 본 연구에서는 소의 심낭에 글루타알데하이드 고정, 용매, 무세포화, 항독성화 처리가 조직의 물리-기계적 장력 및 신장도에 미치는 영향을 알아보고자 하였다. 대상 및 방법: 아무런 처리를 하지 않은 신선한 소의 심낭과 여러 방법의 글루타알데하이드 고정 및 용매 첨가 그룹, 무세포화 그룹, 항독성화 처리 그룹 등으로 나누어 각 조직의 물리-기계적 장력 및 신장도 검사를 시행하였다. 심낭을 30도 각도로 달리하여 얻어낸 6가지 방향에 대하여 폭 5 mm에 대한 인장 강도를 구하여 장력을 측정하였고, 양방향으로 늘려 끊어지는 시점에서의 길이를 측정하여 늘어난 정도를 구하여 신장도를 측정하였다. 결과: 1) 상용 농도의 글루타알데하이드 고정시 장력이 감소하며(n=83, $MPa=11.47{\pm}5.40$, p=0.006) 용매를 첨가하였을 때 장력의 변화는 관찰되지 않았다. 신장도는 글루타알데하이드 고정시 늘어났으며(n=83, strain $(%)=24.55{\pm}9.81$, p=0.00), 용매 첨가시 신장도의 변화는 관찰되지 않았다. 2) 무세포화 처리시 대부분의 장력은 감소하는 경향을 보였으며(p>0.05) 장기간 저농도 용액 처리, 고농도의 세정용매 처리시 장력의 감소가 통계적으로 유의했으며(p=0.01, p=0.00), 신장도는 늘어나는 경향을 보였다. 3) 항독성화 처리 시 장력 및 신장도에 유의한 차이를 보이지 않았다. 결론: 소의 심낭에 글루타알데하이드 고정, 용매, 항독성화 처리 후에는 장력 손실이 관찰되지 않으며 신장도는 증가하는 경향을 보였다. 무세포화에 따른 장력의 손실이 뚜렷하였으나 저 농도 세정제 사용과 고농도 용액처리를 보강한 무세포화 처리에서는 장력의 손실이 향상되었다. 계속해서 더 나은 이식 보철편개발을 위한 다양한 용매의 연구 개발이 필요하다.