• Journal of Biomedical Engineering Research
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• v.28 no.4
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• pp.569-576
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• 2007

Ventricular Assist Device(VAD) has switched its goal from a short-tenn use for bridge-to-transplantation to a long-tenn use for destination therapy, With this goal, the importance of long-tenn reliability gets more interests and importances, H-VAD is an portable extracorporeal biventricular assist device, and adopts an electro-pneumatic driving mechanism. The pneumatic pressure to pump out blood is generated with compression of bellows, and is transmitted in a closed pneumatic circuit through a pneumatic line. The existing pneumatic VAD adopts a air compressor which can generate stable pressures but has defects such as a noise and a size problem. Thus, it is not suitable for being used as a portable device, These problems are covered with adopting a closed pneumatic circuit mechanism with a bellows which has a small size and small noise generation, but it has defects that improper pneumatic setting causes a failure of adequate flow generation. In this study, the pneumatic pressure regulation system is developed to cover these defects of a bellows-type pneumatic VAD. The optimal pneumatic pressure conditions according to various afterload conditions for an optimal flow rate were investigated and the afterload estimation algorithm was developed, The final pneumatic regulation system estimates a current afterload and regulate the pneumatic pressure to the optimal point at a given afterload condition. The afterload estimation algorithm showed a sufficient performance that the standard deviation of error is 8.8 mmHg, The pneumatic pressure regulation system showed a sufficient performance that the flow rate was stably governed to various afterload conditions. In a further study, if a additional sensor such as ultrasonic sensor is developed to monitor the direct movement of diaphragm in a blood pump part, the reliability would be greatly increased. Moreover, if the afterload estimation algorithm gets more accuracy, it would be also helpful to monitor the hemodynamic condition of patients.

• Journal of Chest Surgery
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• v.38 no.8 s.253
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• pp.523-528
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• 2005

Background: Investigation of the change of ventricular function and mitral regurgitation after surgical repair of patient with anomalous origin of left coronary artery from the pulmonary artery (ALCAPA) is key issue for the better surgical outcome. Material and Method: From April 1986 to July 2002, 12 patients presented with ALCAPA. The median age at repair was 4 months. Surgical methods included left coronary artery transfer to the aorta (10), Takeuchi procedure (1), saphenous vein free graft bypass (1). Mitral valve was repaired in 1. Result: There were 2 hospital death $(16.7\%)$. The mean follow-up period was $7.1\pm4.1$ years (range, 7 months to 13 years). Four patients required postoperative circulatory assist for $2.2\pm1.1$ days and one needed left ventricular assist device (LVAD) for 1day. Postoperative echocardiography demonstrated significant improvements in mean fractional shortening $(33.4\pm9.1\%\;vs\;17.7\pm9.6\%,\;n=10,\;p<0.05);$ left ventricular end diastolic dimension $(33.4\pm7.3\;mm\;vs\;44.8\pm7.0\;mm,\;n=10,\;p<0.05)$ and systolic dimension $(22.2\pm7.5\;mm\;vs\;33.4\pm7.9\;mm,\;n=10,\;p<0.05)$. Severities of mitral regurgitation decreased in all survivors at 1st and 4th year follow-up echocardiography. There were 2 reoperation due to residual MR and right ventricular outflow obstruction (Takeuchi case). Conclusion: Anatomic repair of anomalous left coronary artery from the pulmonary artery offered an excellent surgical results, especially in terms of the recovery of left ventricle function and mitral regurgitation. However, preoperative indications for mitral procedure is to be evaluated.

• Journal of Chest Surgery
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• v.43 no.1
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• pp.20-24
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• 2010

Background: Fulminant myocarditis is a rare, but life threatening condition. Its prognosis is related with proper management in the acute phase. A cardiopulmonary support device can be very useful in this phase. We report on our experiences with managing acute fulminant myocarditis with a cardiopulmonary support (CPS) device. Material and Method: We reviewed retrospectively 9 patients who had a CPS device used for their fulminant myocarditis between September, 2006 and October, 2008. A Capiox emergency bypass system (Terumo Inc, Tokyo, Japan) was percutaneously inserted in all the patients. Upon implantation, all the patients were in cardiogenic shock because of ventricular arrhythmia or severe left ventricular dysfunction. The mean left ventricular ejection fraction (EF) was $20{\pm}6%$ according to transthoracic echocardiography. Result: 3 patients died despite CPS. The CPS was bridged to a transplanted heart in one patient. The rest were successfully explanted after a mean time of $107{\pm}70$ hours of running. The mean EF after discharge was $56{\pm}7%$ without dilated cardiomyopathy. Conclusion: Fulminant myocarditis can be fatal, but its prognosis is excellent if these patients receive proper, timely treatment. A cardiopulmonary support device can be very useful in this acute period. However, the implantation and management protocol of cardiopulmonary support are not yet settled. Further study is necessary to lower the complications of cardiopulmonary support for patients with fulminant myocarditis.

• Journal of computational fluids engineering
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• v.20 no.2
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• pp.88-95
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• 2015

Blood pump analysis process includes both mechanical and bio-mechanical aspects. Since a blood pump is a mechanical device, it has to be mechanically efficient. On the other hand, blood pumps function is sensitively related to the blood recirculation; hence, bio-factors such as hemolysis and thrombosis become important. This paper numerically investigates the mechanical and bio-mechanical performances of the Rotaflow in the extracorporeal membrane oxygenation(ECMO), Ventricular Assist Device(VAD), and full-load conditions. The operational conditions are defined as(400[mmHg], 5[L/min.]), (100[mmHg], 3[L/min.]), and (600[mmHg], 10[L/min.]) for ECMO, VAD, and full-load conditions, respectively. The results are presented and analyzed from the mechanical aspect via performance curves, and from bio-mechanical aspect via focusing on hemolytic characteristics. Regions of top and bottom cavities show recirculation in both ECMO and VAD condtions. In addition, Eulerian-based calculation of modified index of hemolysis(MIH) has been investigated. The results demonstrate that the VAD condition has the least risk of hemolysis among the others, while the full-load condition has the highest risk.

• Proceedings of the KOSOMBE Conference
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• v.1996 no.11
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• pp.277-280
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• 1996

We have developed a ground-isolation circuit in order to reduce the noise of the internal controller system for the total artificial heart(TAH) and ventricular assist device(VAD). Using the ground-isolation technique, we could transmit the analog target signal to other pheriperal device including IBM PC via RS232C and polygraph, with no noise. Experimental results of VAD showed that there was less impulsive noise in current signal which caused in our previous conventional system. Therefore it could be proved that implementation of isolation technique is very effective to improve the signal to noise ratios of analog signal transmission for TAH or VAD.

• Journal of Biomedical Engineering Research
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• v.23 no.2
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• pp.131-137
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• 2002

The remote monitoring system including hemodynamic information and pump status of the implanted animal could be helpful during the in vivo experiment or clinical trial for an artificial heart Implantation. In order to monitor the course of the in vivo experiment continuously and anywhere, web-based remote monitoring system was developed, which can monitor pressures(AoP, LAP, RAP, PAP) and flow information as well as the pump operating conditions. The system consists of data sending, storing viewer part. The data sending part was constructed using component object model and the viewer part was constructed using the Java applet. In addition, the dialog box was introduced to communicate earth other instantly and the alarming function was also introduced when the hemodynamic values were out of the desired ranges. The developed remote monitoring system was applied during the in vivo experiment of the BVAD (Bi-ventricular Assist Device) implantation for 1 month and showed designed work without failure.

• Proceedings of the KOSOMBE Conference
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• v.1991 no.11
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• pp.70-74
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• 1991

좌심실보조기의 임상응용범위를 넓히기 위해서 개심술을 하지 않고 좌심실보조기를 적용할 수 있도록 캐뉼라형 좌심실보조기를 이용한 보조순환 실험을 하였다. 좌심실 보조기는 모터의 회전력이 PVC 벨로우즈를 수측, 팽창시키는 전기유압식으로 구동되며 환자는 양쪽 대퇴동맥을 통하여 보조순환을 받도록 되어 있다. 두차례의 동물실험을 통하여 대퇴동맥을 통한 보조 순환방식의 가능성 및 그 효과에 대해서 관찰하였다. 첫 실험은 12kg 개를 이용하여 셀딩거 방법으로 뮬린형 카테터를 디퇴동맥으로 삽입히여, 캐뉼라형 보조순환방법의 가능성을 확인하였고, 두번째 동물실험에서는 내경 4.8 mm의 PVC 카테터를 이용하여 좌심방에 유입카테터를 연결하고 대동맥에 유출카테터를 연결하여 보조순환에 의한 대동맥압의 변화와 혈류량의 변화를 관찰하였다. 보조순환동안 개의 동맥압을 100mmHg로 유지할 수 있었으며, 좌심실내압이 감소하는 것을 관찰할 수 있었다.

• Proceedings of the KOSOMBE Conference
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• v.1992 no.11
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• pp.141-145
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• 1992

심부전 환자의 심근회복을 도울 수 있는 장비인 전기유압방식 좌심실보조기를 개발하였다. 좌심실보조기는 혈액펌프, 압력펌프, 제어기로 구성되어 있으며, 혈액펌프에 내장된 혈액주머니는 동물실험을 위하여 50 ml의 크기로 제작하였다. 좌심실보조기의 성능평가를 위하여 최대 박출량을 측정하고 있으나 실험실에서 측정된 간은 동물 실험에서 관찰되는 것보다 일반적으로 증가된 박출량을 보이게 된다. 이는 생체에서는 좌심방의 체적이 박동 주기에 따라 변하여 좌심실보조기가 받아들일 수 있는 유효 혈액량이 변하는 반면, 모의순환장치에서는 좌심방을 단순 저장고로 사용하기 때문에 좌심방의 박동주기에 따른 체적변화를 감안하지 못하여 생기는 것이다. 본 실험에서는 모의순환 장치에 체적변화 가능한 100ml 크기의 좌심방을 연결하여 좌심방으로 들어오는 혈류량이 제한된 동물실험 상황을 모방하였다. 좌심실보조기의 제어방식중 수측기 이완기 비율(SD 비율)변화에 따른 좌심방 음압발생효과를 관찰한 결과 SD 비율을 40 %로 유지하면 행정거리가 클때도 좌심실의 음압발생을 줄일 수 있는 것을 관찰하였다.

• Journal of Chest Surgery
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• v.30 no.12
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• pp.1167-1174
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• 1997

We retrospectively reviewed a series of 20 patients treated with delayed sternal closure during a 5-year period from 1991 to 1996. Of the 2675 patients with cardiovascular su gery 20 underwent this procedure. Male and female ratio was 11:9, mean age was 6.4 months(range 7 days to 5 years). The indications included unstable hemodynamic profiles after open heart surgery due to myocardial edema and poor lung compliance(15), necessity of mechanical ventricular assist device due to weaning failure(3), and hypoxia after PAB(2). Sternum was closed at a mean interval of 102(range 4 to 213) hours after operation. During delayed sternal closure, central venous pressure was elevated(p<0.05). Mediastinitis and other wound problems did not occur. Sepsis developed in 2 patients and microorganism was confirmed in one of the two patients. Five patients died(mortality 25%). And two of 15 discharged patients died during follow-up period. Cumulative survival rate was 65.0% at 12 months and also 65.0% at 24 months.(Standard error was 10.7%) Delayed sternal closure Is considered to be a good method to decompress the hemodynamically compromised heart. Without that, it is not f asible to come off bypass or to decompress the heart. Of course. careful selection of the indication is imperative.

• Journal of Chest Surgery
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• v.56 no.1
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• pp.6-13
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• 2023

Background: Coronavirus disease 2019 (COVID-19) has been found to cause life-threatening respiratory failure, which can progress to irreversible lung damage. Lung transplantation can be a life-saving treatment in patients with terminal lung disease (e.g., acute respiratory distress syndrome caused by infection). This study aimed to present the clinical course and results after initial lung transplantation in patients with severe COVID-19 who did not recover even with optimal medical care. Methods: From August 2019 to February 2022, this study enrolled 10 patients with COVID-19 (5 men; median age, 55.7 years) who underwent lung transplantation at a single center in Korea. All patients' characteristics, clinical pathway, overall survival, complications, and operative data were collected and analyzed. Results: Veno-venous extracorporeal membrane oxygenation or an oxygenator in a right ventricular assist device circuit was applied to 90% of the patients, and the median length of extracorporeal life support before operation was 48.5 days. There were no cases of mortality after a median follow-up of 372.8 days (interquartile range, 262.25-489 days). The major complications included the requirement for postoperative extracorporeal membrane oxygenation support in 2 cases (20%), re-transplantation in 1 case (10%), and re-exploration due to bleeding in 2 cases (20%). During the follow-up period, 3 out of 10 patients died. Conclusion: Excellent early outcomes were observed for patients who underwent lung transplantation. Thus, lung transplantation can be an effective and feasible treatment for patients with end-stage lung disease caused by COVID-19.