• Journal of Chest Surgery
• /
• 제43권3호
• /
• pp.304-307
• /
• 2010

대동맥 축착증 및 심한 대동맥 협착을 가진 생후 5일의 환자가 대동맥 협착을 해결하려는 중재적 시술 도중 유도 카테터에 의한 우측 경동맥 손상으로 인한 출혈 및 심낭 내 탐폰으로 인한 심정지가 발생하여 심폐소생술 후 체외막성산화기 보조를 받았다. 환자의 체중은 2.4 kg이었다. 1일 후 수술적 완전 교정술을 시행하였으나, 수술 직후 심한 심기능 저하로 인하여 양심실 보조 장치로 순환 보조를 하였고, 3일 후 양심실 보조 장치 이탈에 성공하였다. 이후 환자는 일반적인 치료 후 특별한 문제없이 퇴원하였다.

• Journal of Chest Surgery
• /
• 제27권12호
• /
• pp.977-983
• /
• 1994

From April 1989 to December 1993, total 39 patients who were unable to be weaned off CPB or expected fatal immediate postoperiatively, were treated with ventricular assist device [VAD] or extracorporeal membrane oxygenator[ECMO] at the Royal Children`s Hospital, Melbourne. Ages ranged from 3 day to 19.4 year old and body weights from 2.0Kg to 70Kg. Twenty-seven[69.2%] of 39 patients were weaned to be decannulated successfully and sixteen[41.0%] survived to hospital discharge and late survival rate was twelve[30.8%] of 39 patients. The total follow-up period was 4 to 56 months [32.92$\pm$20.77months] and most of the late survivals showed good myocardial recovery state. From the viewpoint of the assist modality, 29 patients were treated with VAD and among them, 23 were weaned from assist successfully, but among the 8 ECMO patients, only 3 could be weaned, and both modalities were performed to the 2 patients with one weaned. The total duration of assist was from 8 to 428 hours and there was a significant difference between hospital discharged group and hospital death group, which were 83.13$\pm$31.29 hours vs 147.52$\pm$112.03 hours[P=0.032]. Conclusively, at the critical postcardiotomy situation of the paediatrtic patients including various congenital complex disease and procedures, we can choose this VAD or ECMO treatment strategy as the reasonable life saving way except transplantation.

• Clinical and Experimental Pediatrics
• /
• 제50권11호
• /
• pp.1041-1048
• /
• 2007

Not a few patients in children and adolescents are suffering from right ventricular (RV) dysfunction resulting from various conditions such as chronic lung disease, left ventricular dysfunction, pulmonary hypertension, or congenital heart defect. The RV is different from the left ventricle in terms of ventricular morphology, myocardial contractile pattern and special vulnerability to the pressure overload. Right ventricular failure (RVF) can be evaluated in terms of decreased RV contractility, RV volume overload, and/or RV pressure overload. The management for RVF starts from clear understanding of the pathophysiology of RVF. In addition to correction of the underlying disease, management of RVF per se is very important. Meticulous control of volume status, inotropic agents, vasopressors, and pulmonary selective vasodilators are the main tools in the management of RVF. The relative importance of each tool depends on the individual clinical status. Medical assist device and surgery can be considered selectively in case of refractory RVF to optimal medical treatment.

• 기계저널
• /
• 제50권8호
• /
• pp.51-53
• /
• 2010

이 글에서는 항공우주왕복선의 엔진설계 시 사용되었던 CFD(Computational Fluid Dynamics) 기술을 인공심장 개발에 어떻게 적용하여 심장보조장치(Ventricular Assist Device)를 만들었는지 소개하고자 한다.

• 대한의용생체공학회:학술대회논문집
• /
• 대한의용생체공학회 1998년도 추계학술대회
• /
• pp.235-236
• /
• 1998

The purpose of this paper is to develop diaphragm type pneumatic Left Ventricular Assist Device(LVAD) for clinical application and to evaluate its performance through the mock circulation and animal experiment. The blood housing and diaphragm are made by polyurethane. The relations of cardiac output us. beat rate and cardiac output vs. systolic-to-diastolic rate was estimated through the mock test and hemodynamic waves are recorded for the evaluation of VAD. We performed animal experiment and 4 animals survived more than 24hrs. As a result, the hemodynamic data and waves showed this system can be applicable to the animal experiment.

• 대한의용생체공학회:학술대회논문집
• /
• 대한의용생체공학회 1995년도 춘계학술대회
• /
• pp.247-250
• /
• 1995

The purpose of this paper is to develop diaphragm-type pneumatic ventricular assist device(VAD) for clinical application and to evaluate its performance through the mock circulation system. The blood housing and diaphragm are made by coating pellethane on the metallic mold and the back plate is made by machining process. The relations of cardiac output(CO) vs. beat rate and CO vs. systolic-to-diastolic rate was estimated through the mock test and hemodynamic waves are recorded for the evaluation of VAD. As a result, the volume of blood pump is 70 ml, maximum CO is 5 L/min and CO has a close relation to the input resistance of blood pump. The hemodynamic data and waves showed this system can be applicable to the animal experiment.

• 한국지능시스템학회:학술대회논문집
• /
• 한국퍼지및지능시스템학회 1995년도 추계학술대회 학술발표 논문집
• /
• pp.387-392
• /
• 1995

전기 유압식 좌심실 보조장치에서 모터 전류 파형을 정보로 하여 작동기의 이완기 속도를 조절함으로써 좌심방으로부터 유입되는 혈류량을 조절하는 알고리즘을 개발하였다. 좌심실 보조장치(Left Ventricular Assist Device, LVAD)는 허혈성 심장질환 등으로 좌심실 의 혈액 박출 기능이 저하된 환자에게 시술하여 정상 상태의 심박출량을 유지할 수 있도록 하는 보조 혈액 박출 기능이이다. 전기 유압식 좌심실 보조장치에서는 혈액의 유입이 능동 적으로 이루어지므로, 좌심방 함몰로 인한 심근 손상 및 외부 공기 유입으로 인한 색전증을 방지하기 위해 유입혈류량을 현재 좌심방내의 상태에 따라 적절히 조절해 주어야 한다. 좌 심방 내의 혈액량 정도는 혈액을 유입해 내는 작동기의 이완기 동작 시에 소모되는 에너지 크기에 반영되고, 작동기를 구동하는 모터에 들어가는 전류의 크기는 작동기에 공급되는 에 너지에 비례하므로, 이전류 파형의 정보들을 통해 좌심방내의 상태를 추정해 볼 수 있다. 본 논문에서는 퍼지로직을 적용하여 모터 전류 파형의 정보들을 통해 좌심방 내의 상태를 추정 해 볼 수 있다. 본 논문에서는 퍼지로직을 적용하여 모터 전류 파형의 이상 유무를 판단한 뒤 에에 따라 작동기의 이완기 속도를 조절하는 알고리즘을 개발하여 모의순환장치 실험을 통해 그 실효성을 검증한 결과를 정리하였다.

• 대한의용생체공학회:의공학회지
• /
• 제15권1호
• /
• pp.19-26
• /
• 1994

Sulfonated poly (ethyleneoxide)-grafted polyurethane (PU-PEO-$SO_3$) prepared by bulk modification was coated on a blood sac for electrohydraulic left ventricular assist device (ELVAD) implanted in dogs and its in vivo blood compatibility on shear stress was studied as compared with untreated Po. The effect of the wall shear stress on the protein adsorption unlike platelet adhesion is dependent on the surface characteristics of the material, although less proteins seem to be adsorbed in the region of the high shear stress. The thickness of total proteins adsorbed on PU-PEO-SOJ (400 ${\AA}$) by trans¬mission electron microscopy(TEM) was considerably lower than that of untreated PU(l,000~1,600 ${\AA}$), but PU-PEO-$SO_3$ showed high albumin adsorption, low fibrinogen and IgG adsorption, and low platelet adhesion as compared with untreated PU, suggesting that PU-PEO-$SO_3$ is more in vivo blood compatible. Therefore, it appears that such a blood compatible PU-PEO-$SO_3$ is useful for blood contacting biomaterials including artificial organs.

• Journal of Chest Surgery
• /
• 제34권6호
• /
• pp.490-493
• /
• 2001

17세 여자 고등학교 학생이 전흉부 동통을 주소로 입원하였다. 약물 치료와 대동맥내 풍선 펌프에도 불구하고 폐부종과 순환 허탈이 악화되었다. 급성 전격성 심근염 추정 진단 하에 좌심실 보조장치를 설치하였다. 유입구 도관은 유방하 좌전개흉술로 좌심이를 통하여 좌심방에 삽입하였고, 좌심이의 일부를 조직검사를 위해 떼어냈다. 유출구 도관은 좌측 대퇴 동맥에 PTFE도관을 간치시켜 삽입하였다. 체외순환 158시간 후 심초음파에서 좌심실의 운동성이 거의 정상으로 회복되었고, 좌심실 보조장치를 성공적으로 이탈할 수 있었다. 면역화학 검사와 중화 항체 검사에서 콕사키바이러스가 확인되었다. 환자는 입원 23일 째 아무런 심부전 증상없이 퇴원하였다.

• 임상간호연구
• /
• 제28권2호
• /
• pp.167-176
• /
• 2022

Purpose: Driveline infection (DLI) is one of the major adverse events of Left Ventricular Assist Device (LVAD). The purpose of this study was to explore the incidence of DLI according to the driveline dressing methods. Methods: This study was a retrospective cohort study that investigated the medical records of 75 patients who implanted LVAD from January 2015 to December 2020 at a hospital in Seoul, Korea. Traditionally, sandwich dressing method was applied until October 2019, after which newly winded dressing method was adopted for driveline dressing to LVAD patients. The outcome variables were compared between sandwich dressing method applied group (n=41) and winded dressing method applied group (n=34). The follow-up period for DLI was 1 year. Results: When compared participants' characteristics, there was no difference between the two groups, except the type of LVAD device. The incidence of DLI was 17.1% in sandwich dressing group, while no infection was found in winded dressing group (p=.011). Conclusion: Although there were difference in the LVAD devices, it is considered that winded dressing contributed to the reduction of DLI. Further research on standardized dressing methods was required for DLI prevention in Korea.