• Journal of Chest Surgery
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• 제12권4호
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• pp.383-394
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• 1979

Treatment of valvular heart disease with valve replacement has been one of the most popular procedures in cardiac surgery recently. Although, first effort was directed toward the prosthetic valve, it soon became popular that bioprosthesis, the valvular xenograft, was prefered in the majority cases. Valvular xenograft has some superiority to the artificial prosthetic valve in some points of thromboembolism and hemolytic anemia, and it also has some inferiority of durability, immunologic reaction and resistance to Infection. Tremendous efforts were made to cover the inferiority with several methods of collection, preservation, and valve mounting of the porcine valve or pericardium of the calf, and also with surgical technique of the valvular xenograft replacement. Auther has collected 320 porcine aortic valves immediately after slaughter, and aortic cusps were coapted with cotton balls in the Valsalva sinuses to protect valve deformity after immersion in the Hanks' solution, and oxidation, cross-linking and reduction procedures were completed after the proposal of Carpentier in 1972. Well preserved aortic valves were suture mounted in the hand-made tissue valve frame of 19, 21, and 23 mm J.d., and also in the prosthetic vascular segment of 19 mm Ld. with 4-0 nylon sutures after careful trimming of the aortic valves. Completed valves were evaluated with bacteriologic culture, pressure tolerance test with tolerane gauge, valve durability test in the saline glycerine mixed solution with tolerance test machine in the speed of 300 rpm, and again with pathologic changes to obtain following results: 1. Bacteriologic culture of the valve tissue in five different preservation method for two weeks revealed excellent and satisfactory result in view of sterilization including 0.65% glutaraldehyde preservation group for one week bacteriologic culture except one tissue with Citobacter freundii in 75% ethanol preserved group. 2. Pressure tolerance test was done with an apparatus composed of V-connected manometer and pressure applicator. Tolerable limit of pressure was recorded when central leaking jet of saline was observed. Average pressure tolerated in each group was 168 mmHg in glutaraldehyde, 128 mmHg in formaldehyde, 92 mmHg in Dakin's solution, 48 mmHg in ethylene oxide gas, and 26 mmHg in ethanol preserved group in relation to the control group of Ringer's 90 mmHg respectively. 3. Prolonged durability test was performed in the group of frame mounted xenograft tissue valve with 300 up-and-down motion tolerance test machine/min. There were no specific valve deformity or wearing in both 19, 21, and 23 mm valves at the end of 3 months (actually 15 months), and another 3 months durability test revealed minimal valve leakage during pressure tolerance test due to contraction deformity of the non-coronary cusp at the end of 6 months (actually 30 months) in the largest 23 mm group. 4. Histopathologic observation was focussed in three view points, endothelial cell lining, collagen and elastic fiber destructions in each preservation methods and long durable valvular tolerance test group. Endothel ial cell lining and collagen fiber were well preserved in the glutaraldehyde and formaldehyde treated group with minimal destruction of elastic fiber. In long durable tolerance test group revealed complete destruction of the endothelial cell lining with minimal destruction of the collagen and elastic fiber in 3 month and 6 month group in relation to the time and severity. In conclusion, porcine xenograft treated after the proposal of Carpentier in 1972 and preserved in the glutaraldehyde solution was the best method of collection, preservation and valve mounting. Pressure tolerance and valve motion tolerance test, also, revealed most satisfactory results in the glutaraldehyde preserved group.

• Journal of Chest Surgery
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• 제38권10호
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• pp.675-679
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• 2005

배경: 삼중 판막 대치술의 임상적 결과에 대한 문헌들은 매우 드물다. 대랄 및 방법. 1992년 1월부터 2003년 12월까지 38명의 환자가 연세 심장혈관 병원에서 삼중 판막에 대한 대치술을 시행받았다. 평균 나이는 $49.5\pm10.7 (28\~69)$세였으며 24명이 여자였다. 류마치스성 심장 판막 질환이 가장 흔한 원인이었고(n=37), 수술 전 New York Heart Association (NYHA) functional class는 II가 4명, III가 24명, IV가 10명이었다. 15명의 환자는(group 1) 최초의 수술에서 삼중 판막 대치술을 시행 받은 경우였고, 23명의 환자는(group 2) 이전에 일회 이상의 심장 수술을 받았으며 한 명을 제외하고는 삼첨 판막 대치술을 제일 나중에 시행 받은 경우였다. 7명의 환자는 최초 수술에서 삼첨 판막 성형술을 받은 후 삼첨 판막 대치술을 시행 받은 환자들이었다. 걸과 수술 사망은 6명$(15.8\%)$이었으며 모두 group 2에 속하는 환자들이었다. 최초 수술에서 삼중 판막 대치술을 시행 받은 15명의 환자는 수술 사망 없이 모두 퇴원하였다. 평균 $66.0\pm40.7$개월의 추적 관찰 기간 중에 만기 사망은 3명$(9.4\%)$에서 있었으며 대부분의 환자에서 NYHA functional class의 향상을 보였다. 4명의 환자에서 인공 판막과 관련된 합병증이 있었으며, 10년 생존율은 $68.8\%$였고, 생존자에 있어서 재수술을 포함한 10년 무사고 생존율은 $85.5\%$였다. 결론: 삼중 판막 대치술 후에 대부분의 환자에서 증상의 호전을 보였다. 그리고 추적 관찰기간 중에 인공 판막과 관련된 합병증 발생 및 생존율은 만족할 만한 결과를 보였다. 따라서 적응이 되는 경우에는 환자의 상태가 더 나빠지기 전에 삼중 판막 대치술을 적극적으로 고려해야 할 것이다.

• Journal of Chest Surgery
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• 제18권2호
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• pp.299-304
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• 1985

The partial A-V canal defect consist of ostium primum type atrial septal defect with a cleft mitral anterior leaflet. The clinical findings depend upon the site and size of the left-to-right shunt, the degree of A-V valvular regurgitation, and the degree of resultant pulmonary artery hypertension. We experienced 3 cases of similar condition. The data were as follow: 1. Chest P-A showed increased pulmonary vascularity and moderate cardiomegaly with left atrial enlargement. 2. E.K.G. showed left axis deviation, left atrial enlargement, and left ventricular hypertrophy. 3. Right heart catheterization showed significant 02 step up of SVC-RA and left-to-right shunt. 4. Left ventriculogram showed mitral regurgitation and filling of both atrium. Operative findings were as follow: 1. Primum type atrial septal defect [2x2 cm]. 2. Cleft in the anterior leaflet of the mitral vave. 3. No evidence of ventricular septal defect and tricuspid anomaly. Through a right atriotomy with moderate hypothermia, the mitral cleft was approximated with interrupted sutures. The interatrial communication was closed by a patch of Dacron/pericardium. The patch was attached to junction of the mitral and tricuspid valves along the crest of the ventricular septum using interrupted sutures and the other site using continuous sutures. Postoperative course was uneventful and discharged in good general condition except postoperative bleeding in case 3.

• Biomaterials and Biomechanics in Bioengineering
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• 제3권3호
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• pp.141-155
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• 2016

Two-dimensional (2D) cell culture and in vivo cancer model systems have been used to understand cancer biology and develop drug delivery systems for cancer therapy. Although cell culture and in vivo model studies have provided critical contribution about disease mechanism, these models present important problems. 2D tissue culture models lack of three dimensional (3D) structure, while animal models are expensive, time consuming, and inadequate to reflect human tumor biology. Up to the present, scaffolds and 3D matrices have been used for many different clinical applications in regenerative medicine such as heart valves, corneal implants and artificial cartilage. While tissue engineering has focused on clinical applications in regenerative medicine, scaffolds can be used in in vitro tumor models to better understand tumor relapse and metastasis. Because 3D in vitro models can partially mimic the tumor microenvironment as follows. This review focuses on different scaffold production techniques and polymer types for tumor model applications in cancer tissue engineering and reports recent studies about in vitro 3D polymeric tumor models including breast, ewing sarcoma, pancreas, oral, prostate and brain cancers.

• Parasites, Hosts and Diseases
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• 제34권2호
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• pp.151-154
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• 1996

저자 등은 1987넌에 인공 관막 치환수술을 받고 심방 내 혈전 형성을 예방하기 위하여 항응호제를 계속적으로 복용하여 오던 71세 남자가 우측 안면 및 상, 하지 운동 마비와 실어증을 주소로 1994년(9원 28일) 성남 인하병원에 입원하게 되었고 입원 11일째부터 사망하기까지 특수 유통식 공금을 위하여 위장 내로 투입한 비강 영양 튜우브(nasogastrictube)를 통하여 수 마리의 파리 유충(maggot)이 역류되어 나왔고, 구강 내에서도 총 45마리의 구더기가 발견된 증례를 경험하였다 이 파리 유충은 병균 11.5 mm 길이로서 걸정파리과(Calliphoridae) 금파리속(Lucllia)의 1종이었으며 위. 장관계에 병소를 갖고 있었음이 추정되었다. 본 내부 승저증(internal myiasis) 증례는 우리 나라에서 처음 보고되는 것이다.

• Journal of mucopolysaccharidosis and rare diseases
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• 제2권1호
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• pp.31-31
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• 2016

Purpose: To describle clinical features and enzyme activity of Vietnamese patients with Mucolipidosis type II. Methods: Clinical features, laboratory and plasma lysosom enzyme activity by 4 MU-Fluorometric assay was studied from 2014-2015 at the Northern referral center of Pediatrics - National Children's Hospital. Results: 16 cases (7 girls and 9 boys) were diagnosed with I-cell bases on clinical symptoms and enzyme activities studies. Diagnosis age was $5.93{\pm}4.28$ years, onset age was recognised from birth to 4 years (median 1.25) with the feature of joint stiffness and bone deformation. All cases presented with the feature of joint stiffness, chest deformation and kyphoscoliosis; Fifteen cases (93.7%) had coarse facial features. No patients had hepatosplenomegaly on abdominal ultrasound, 5/15 patients had heart valves disease. Enzyme assay showed ${\alpha}$-Hexosaminidase of $1,885.9{\pm}338.7$ (nmol/mg plasma/17 hrs), ${\alpha}$-Iduronate sulfatase of $4,534.8{\pm}1,062.9nmol/mg$ plasma/4 hrs). Conclusion: Mucolipidosis II seriously affected the life of the patients with skeletal deformities, contractures develop in all joints and cardiac involvement.

• 융합신호처리학회논문지
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• 제14권1호
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• pp.1-5
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• 2013

The two major problems related to the blood flow in replaced prosthetic heart valve are thrombus formation and hemolysis. Reliability of prosthetic valve is very important because its failure means the death of patient. There are many factors affecting the valvular failures and their representatives are mechanical failure and thrombosis, so early noninvasive detection is essentially required. The purpose of this study is to detect the various thromboses formation by using acoustic signal acquisition and its spectral analysis on the frequency domain. We made the thrombosis models using Polydimethylsiloxane (PDMS) and they are thrombosis model on the disc, around the sewing ring and fibrous tissue growth across the orifice of valve. Using microphone and amplifier, we measured the acoustic signal from the prosthetic valve, which is attached to the pulsatile mock circulation system. A/D converter sampled the acoustic signal and the spectral analysis is the main algorithm for obtaining spectrum. Then the spectrum of normal and 5 different kinds of abnormal valve were obtained. Each spectrum waveform shows a primary and secondary peak. The secondary peak changes according to the thrombus model. To quantitatively distinguish the frequency peak of the normal valve from that of the thrombosed valves, analysis using a neural network was employed. Acoustic measurement has been used as a noninvasive diagnostic tool and is thought to be a good method for detecting possible mechanical failure or thrombus.

• Journal of Chest Surgery
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• 제36권4호
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• pp.273-276
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• 2003

좌심실 가성류로 내원한 39세 남자 환자에 대한 수술 치험 예를 보고하고자 한다. 환자는 4년 전 판막륜 농양을 동반한 감염성 심내막염으로 기계판막을 이용한 대동맥판막 및 승모판막 치환술과 농양 제거수술을 받았다. 수술 후 시행한 심초음파 소견상 좌심실과 농양이 있던 공동 사이에 교통이 있음이 관찰되었고, 추적 관찰 심초음파 검사에서 점차 공동의 크기가 증가하였다. 수술은 심페바이패스와 심정지하에 대동맥판막-승모판막 섬유연속부에 위치한 가성류와 좌심실 사이의 결손을 첩포폐쇄하였다. 수술 후 경과는 양호하였으며 수술 후 9일째에 합병증 없이 퇴원하였다.

• Journal of Chest Surgery
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• 제16권4호
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• pp.458-469
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• 1983

Between October, 1978, and December, 1982, Glutaraldehyde-stablized pericardial xenografts [Ionescu-Shiley valve] were used for heart valve replacement in 409 patients.[251 mitral, 49 aortic, 11 tricuspid, and 98 multiple valve replacement]. There were 31 early deaths [7.6%], and 371 operative survival were observed for a total of 507.6 years over a period of 1 to 44 months. [mean 17 months]. Actuarial analysis of late results indicates an excepted survival rate at 4 years of 86.25.4% for patients with mitral, 79.37.1% for patients with aortic valve replacement. Actuarial survival rates for total patients at 4 years was 77.88.2%. The rate of systemic embolism has been 1.6% per patient-year for mitral and 1.8% per patient-year for aortic group in the presence of anticoagulation treatment. Among the 6 embolic episodes, 2 patients were died. The incidence of hemorrhagic complication was 1.3% per patient-year for anticoagulated patients. There were 6 confirmed valve failures, five in mitral and one in aortic position. Re-replacement of destructed valve was performed in one patient and others were treated medically. Among the 6 episodes, 3 occurred in children [Below 15 years], it account almost 9 times higher than adult. Our clinical data compare very favorable with those obtained with other available prostheses and tissue valves, but it should be considered to give short-term anticoagulation therapy to hemodynamically stable patients and aortic valve patients, and other prosthetic valve must be considered to use in children.

• Journal of Chest Surgery
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• 제46권4호
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• pp.285-288
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• 2013

Prosthetic valves are being widely used in the treatment of heart valve disease. Prosthetic valve endocarditis (PVE) is one of the most catastrophic complications seen in these patients. In particular, prosthetic valve dehiscence can lead to acute decompensation, pulmonary edema, and cardiogenic shock. Here, we discuss the medical management of late PVE in a patient with a prior history of late and redo early PVE and recurrent dehiscence. According to the present case, we can summarize the learning points as follows. A prior history of infective endocarditis increases the risk of relapse or recurrence, and these patients should be evaluated very cautiously to prevent late complications. Adequate debridement of infected material is of paramount importance to prevent relapse. A history of dehiscence is associated with increased risk of relapse and recurrent dehiscence.