BACKGROUND: In this study, we investigated the early time course of expression of the major histocompatibility (MHC) antigens, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), interleukin-6 and the histopathological changes in the coronary arteries of cardiac allografts exchanged between inbred mice strains that differ in one loci of class I major histocompatibility antigen (B10.BR to B10.A). MATERIAL AND METHOD: No immunosuppressive therapy was used. Both allografts and the hearts of the recipients were harvested at 7 (group 1, n=6), 15 (group 2, n=6), 21 (group 3, n=6), and 30 (group 4, n=6) days after transplantation. They were examined by immunohistochemistry, microscopy and morphometry. All allografts had contractions at the time of harvest. RESULT: A strong MHC class I antigen expression was present on the endothelial and medial cells of the coronary arteries in group 1 and remained unchanged in the rest of the groups. However, MHC class II reactivity was none or very little at any time. Mild to moderate ICAM-1 expression was observed on the endothelial cells, but not on the medial cells at any time by 30 days. VCAM-1 expression was strong both on the endothelial and medial cells at any time. Moderate degree expression of interleukin-6 was observed from 7 to 30 day specimens. Histopathologically, percentage of affected vessels (vessels with intimal thickening) was less than 10 % in 7 day group and increased up to 50 % at 30 days. Mean percent narrowing of the lumen of the affected vessels revealed less than 20 % at 7 days and 40 % at 30 days. The area occupied by tropomyosin positive cells in the intimal lesion, graded from 0 to 3, showed gradual increase but remained between grade 0 to 1 by 30 days. Medial integrity was also well preserved at any time. Moderate perivascular mononuclear cell infiltration was observed at 7 days and it was progressively increased upto 30 days. Recipients' heart revealed no positive immunopathologic findings. CONCLUSION: In this study, the early time course of progression of the transplantation vasculopathy was demonstrated in the murine heterotopic heart transplant model.
Allergy and Immunology ; Allografts ; Animals ; Atherosclerosis ; Coronary Vessels* ; Endothelial Cells ; Heart* ; Histocompatibility ; Histocompatibility Antigens ; Immunohistochemistry ; Intercellular Adhesion Molecule-1 ; Interleukin-6 ; Mice* ; Microscopy ; Transplantation ; Tropomyosin ; Vascular Cell Adhesion Molecule-1

Hypertensive intracerebral hemorrhage is one of the important diseases in Korea, sociomedically, in view of high incidence and mortality rate of the disease, severity of its sequelae and the affected productive age-group of 40 to 50 years old. The indications for surgery in hypertensive intracerebral hemorrhage are still controversial. The reason for this may be : 1) lack of adequate and comparable data in conservative and surgical therapy from the same institution : 2) lack of adequate close follow-up monitoring over an extended period of time ; or 3) lack of proper classification of hematomas for comparison of results from different institutions. The authors analysed 1009 cases of hypertensive intracerebral hemorrhage admitted to the Department of Neurosurgery, Kyung-Hee University Medical center for five years from January 1983 to December 1987. The site of hemorrhage have classified according to their anatomical site on computerized tomography. The long term outcome was analysed with reference to comparison between surgical treatment and conservative treatment. The results were as follows : 1) The incidence was high in the age-group of 50 years old and the sex ration was 1.23 : 1.0. 2) There was no seasonal variation in the incidence. 3) The occurrence of putamino-thalamic hemorrhage(38.7%) was most frequent, and then followed by putaminal(17.9%), thalamic(17.9%), subcortical(13.6%), pontine(7.5%), cerebellar(4.4%) hemorrhage in order. 4) The outcome was satisfactory in the cases of subcortical hemorrhage and cerebellar hemorrhage. The outcome was poorest in the cases of pontine hemorrhage. Both putamen and thalamic hemorrhage had brought about a high licidence of severe sequelae. 5) In correlation between the therapeutic modality and the outcome, surgical treatment increased the frequency of improvement towards Grade I-II, and also decreased the frequency of Grade III, but brought about the increase of the mortality rate. In general this results failed to support the view that the surgical treatment is superior to the conservative one in the management of hypertensive intracerebral hemorrhage. But, in the subcortical and cerebellar hemorrhage, surgical treatment showed better outcome than conservative treatment. 6) The outcome was poor in large sized hemorrhage than small one. In cases with large sized subcortical and cerebellar hemorrhage, surgical treatment had low mortality rate. 7) The level of consciousness at attack had closely related to the outcome. 8) In correlation between the time interval from ictus till operation and outcome, generally speaking, the outcome of delayed operation was slightly better than early operation. But, when the level of consciousness was good, the outcome of early operation was satisfactory. 9) Intraventricular hemorrhage occurred in 38.9% of all cases, and most frequently associated with thalamic hemorrhage. In the case of association with intraventricular hemorrhage, the mortality rate was greatly increased than in cases without intraventricular hemorrhage. 10) As far as the causes of death were concerned, cerebral swelling was most frequent and overall mortality rate was 22%.
Academic Medical Centers ; Blood Loss, Surgical ; Cause of Death ; Classification ; Consciousness ; Follow-Up Studies ; Hematoma ; Hemorrhage ; Humans ; Incidence ; Intracranial Hemorrhage, Hypertensive* ; Korea ; Middle Aged ; Mortality ; Neurosurgery ; Putamen ; Seasons

We evaluated CT findings of bronchial carcinoid and accuracy of preoperative pathological diagnosis according to two subtypes. The subjects were 10 cases (typical;5, atypical;5), confirmed by surgery and tissue pathology. Sputum cytology (n=10), percutaneous aspiration (n=1) and bronchoscopic biopsy (n=8) were performed, preoperatively. The CT findings were analysed according to two subtypes. Typical carcinoid shows central location in all, and bronchial lumens just proximal to tumor were widened in two, whereas atypical carcinoid presented as peripheral leison in two. Among central atypical carcinoid, two cases showed flat meniscus appearance of lumen. Remaining one showed diffuse wall thickening. Intratumoral low density by necrosis was noted in one. Both subtypes show contrast enhancement. For preoperative diagnosis, sputum cytology & percutaneous aspiration were not conclusive at all. As for bronchoscopic biopsy, only 3 cases were accurately diagnosed as typical carcinoid. Typical carcinoid presented as endobronchial mass in all, whereas atypical carcinoid presented in various appearance. In all atypical & some typical carcinoid were misdiagnosed as primary lung cancer, preoperatively. However, in typical carcinoid, conservative surgery was possible. In conclusion, if there is discrepancy between CT findings & preoperative pathological diagnosis, full understanding of CT findings of bronchial carcinoid is imperative to choose appropriate surgical modality.
Biopsy ; Carcinoid Tumor* ; Diagnosis* ; Lung Neoplasms ; Necrosis ; Pathology ; Sputum

Objective: To evaluate the impact of surgical simulation training using a three-dimensional (3D)-printed model of tetralogy of Fallot (TOF) on surgical skill development. Materials and Methods: A life-size congenital heart disease model was printed using a Stratasys Object500 Connex2 printer from preoperative electrocardiography-gated CT scans of a 6-month-old patient with TOF with complex pulmonary stenosis.Eleven cardiothoracic surgeons independently evaluated the suitability of four 3D-printed models using composite Tango 27, 40, 50, and 60 in terms of palpation, resistance, extensibility, gap, cut-through ability, and reusability of. Among these, Tango 27 was selected as the final model. Six attendees (two junior cardiothoracic surgery residents, two senior residents, and two clinical fellows) independently performed simulation surgeries three times each. Surgical proficiency was evaluated by an experienced cardiothoracic surgeon on a 1–10 scale for each of the 10 surgical procedures. The times required for each surgical procedure were also measured. Results: In the simulation surgeries, six surgeons required a median of 34.4 (range 32.5–43.5) and 21.4 (17.9–192.7) minutes to apply the ventricular septal defect (VSD) and right ventricular outflow tract (RVOT) patches, respectively, on their first simulation surgery. These times had significantly reduced to 17.3 (16.2–29.5) and 13.6 (10.3–30.0) minutes, respectively, in the third simulation surgery (p = 0.03 and p = 0.01, respectively). The decreases in the median patch appliance time among the six surgeons were 16.2 (range 13.6–17.7) and 8.0 (1.8–170.3) minutes for the VSD and RVOT patches, respectively. Summing the scores for the 10 procedures showed that the attendees scored an average of 28.58 ± 7.89 points on the first simulation surgery and improved their average score to 67.33 ± 15.10 on the third simulation surgery (p = 0.008). Conclusion Inexperienced cardiothoracic surgeons improved their performance in terms of surgical proficiency and operation time during the experience of three simulation surgeries using a 3D-printed TOF model using Tango 27 composite.

Objective: To evaluate the impact of surgical simulation training using a three-dimensional (3D)-printed model of tetralogy of Fallot (TOF) on surgical skill development. Materials and Methods: A life-size congenital heart disease model was printed using a Stratasys Object500 Connex2 printer from preoperative electrocardiography-gated CT scans of a 6-month-old patient with TOF with complex pulmonary stenosis.Eleven cardiothoracic surgeons independently evaluated the suitability of four 3D-printed models using composite Tango 27, 40, 50, and 60 in terms of palpation, resistance, extensibility, gap, cut-through ability, and reusability of. Among these, Tango 27 was selected as the final model. Six attendees (two junior cardiothoracic surgery residents, two senior residents, and two clinical fellows) independently performed simulation surgeries three times each. Surgical proficiency was evaluated by an experienced cardiothoracic surgeon on a 1–10 scale for each of the 10 surgical procedures. The times required for each surgical procedure were also measured. Results: In the simulation surgeries, six surgeons required a median of 34.4 (range 32.5–43.5) and 21.4 (17.9–192.7) minutes to apply the ventricular septal defect (VSD) and right ventricular outflow tract (RVOT) patches, respectively, on their first simulation surgery. These times had significantly reduced to 17.3 (16.2–29.5) and 13.6 (10.3–30.0) minutes, respectively, in the third simulation surgery (p = 0.03 and p = 0.01, respectively). The decreases in the median patch appliance time among the six surgeons were 16.2 (range 13.6–17.7) and 8.0 (1.8–170.3) minutes for the VSD and RVOT patches, respectively. Summing the scores for the 10 procedures showed that the attendees scored an average of 28.58 ± 7.89 points on the first simulation surgery and improved their average score to 67.33 ± 15.10 on the third simulation surgery (p = 0.008). Conclusion Inexperienced cardiothoracic surgeons improved their performance in terms of surgical proficiency and operation time during the experience of three simulation surgeries using a 3D-printed TOF model using Tango 27 composite.

Percutaneous transcatheter closure of atrial septal defects as a therapeutic alternative in appropriate patients provides superior cosmetic results, is less invasive, and allows for shorter hospital stays. Unfortunately, however, such percutaneous procedures can be associated with catastrophic procedure complications that may require immediate surgical intervention. We report a case of aorta-to-right atrial fistula two months after transcatheter occlusion of an atrial septal defect by an Amplatzer septal occluder. Revealed by dyspnea, palpitation and hemolysis, this complication needed an emergency surgical operation. The fistula between the noncoronary Valsalva sinus of the aorta and the right atrium was repaired. The atrial septal defect was closed by patch. The cause of this serious complication appears to be erosion into the aorta by the right atrial disk.
Aorta* ; Dyspnea ; Emergencies ; Fistula* ; Heart Atria* ; Heart Septal Defects, Atrial* ; Hemolysis ; Humans ; Length of Stay ; Prostheses and Implants ; Septal Occluder Device ; Sinus of Valsalva

BACKGROUND: Bioprostheses for cardiovascular surgery have limitations in their use following as calicification. alpha-galactosidase epitope is known as a stimulant of immune response and then shows a progressing calcification. The objective of this study was to evaluate histologic characteristics and mechanical properties of decellularization and treated with alpha-galactosidase. MATERIALS AND METHODS: Bovine pericardial tissues were allocated into three groups: fixation only with glutaraldehyde, decellularization with sodium dodesyl sulfate and decellularization plus treatment with alpha-galactosidase. We confirmed immunohistological characteristics and mechanical properties as fatigue test, permeability test, compliance test, tensile strength (strain) test and thermal stability test. RESULTS: Decellularization and elimination of alpha-gal were confirmed through immunohistologic findings. Decellularization had decreased mechanical properties compared to fixation only group in permeability (before fatigue test p=0.02, after fatigue test p=0.034), compliance (after fatigue test p=0.041), and tensile strength test (p=0.00). The group of decellularization plus treatment with alpha-galactosidase had less desirable mechanical properties than the group of decellularization in concerns of permeability (before fatigue test p=0.043) and strain test (p=0.001). CONCLUSION: Favorable decellularization and elimination of alpha-gal were obtained in this study through immunohistologic findings. However, those treatment including decellularization and elimination of alpha-gal implied the decreased mechanical properties in specific ways. We need more study to complete appropriate ioprosthesis with decellularization and elimination of alpha-gal including favorable mechanical properties too.
alpha-Galactosidase ; Bioprosthesis ; Compliance ; Fatigue ; Glutaral ; Pericardium ; Permeability ; Sodium ; Sprains and Strains ; Tensile Strength

BACKGROUND: As life expectancy has been increased, the cardiac valve disease has been increased. In past, mechanical valve for valve replacement surgery was used widely, but it has many weaknesses, such as hemorrhage, teratogenic effect caused by warfarin, acute mechanical failure, taking warfarin during life, etc. So, the tissue valve is used widely and researches for durability of tissue valve are in progress. Tissue valves being used are all imported in Korea, and there is a lack of information on its geometry and design. So, we studied the geometry of porcine aortic and pulmonary valve, and tried to suggest theoretical basis for making the aortic and pulmonary valve. MATERIAL AND METHOD: We harvested aortic and pulmonary valves of 25 pigs and measured the geometry of valve at fresh and glutaraldehyde (GA) fixed state. In each group, we measured the diameter of the base, diameter of commissure, valve height, commissural height, etc. Also, for making implantable porcine and bovine pericardial valve, we designed the valve stent form, thickness, height, and leaflet size, form, thickness by different size of valve. RESULT: The aortic and pulmonary valve geometry and ratio were measured in each group. The right coronary cusp of aortic valve and right facing cusp of pulmonary valve was bigger than other cusps and non coronary cusp was smaller than others (RCC:NCC:LCC=1:0.88:1). Valve height was correlated to the leaflet size. We designed the outer diameter of stented porcine aortic valve from 19 mm to 33 mm and designed stent height and width, using previous measured ratio of each structure, stent thickness, working thickness (for making valve). Also, we designed the size of stent and form for stented bovine pericardial valve, considering diameter of valve, leaflet length, height and leaflet minimum coaptation area. CONCLUSION: By measuring of 25 pig's aortic and pulmonary valve geometry and ratio, we can make theoretical basis for making implantable stented porcine valve and bovine pericardial valve in various size. After making implantable valve using these data, it is necessary to do in vivo and in vitro researches, furthermore.
Aortic Valve ; Glutaral ; Heart Valves ; Hemorrhage ; Korea ; Life Expectancy ; Pulmonary Valve ; Stents ; Swine ; Tissue Engineering ; Warfarin

BACKGROUND AND OBJECTIVES: Mechanical circulatory support with extracorporeal membrane oxygenation (ECMO) and ventricular assist device has always been the optimal choice for treating the majority of medically intractable low cardiac output case. We retrospectively investigated our institution's outcomes and variables associated with a high risk of mortality. SUBJECTS AND METHODS: From 1999 to 2014, 86 patients who were of pediatric age or had grown-up congenital heart disease underwent mechanical circulatory support for medically intractable low cardiac output in our pediatric intensive care unit. Of these, 9 grown-up congenital heart disease patients were over 18 years of age, and the median age of the subject group was 5.82 years (range: 1 day to 41.6 years). A review of all demographic, clinical, and surgical data and survival analysis were performed. RESULTS: A total of 45 (52.3%) patients were successfully weaned from the mechanical assist device, and 25 (29.1%) survivors were able to be discharged. There was no significant difference in results between patients over 18 years and under 18 years of age. Risk factors for mortality were younger age (<30 days), functional single ventricle anatomy, support after cardiac operations, longer support duration, and deteriorated pre-ECMO status (severe metabolic acidosis and increased levels of lactate, creatinine, bilirubin, or liver enzyme). The survival rate has improved since 2010 (from 25% before 2010 to 35% after 2010), when we introduced an upgraded oxygenator, activated heart transplantation, and also began to apply ECMO before the end-stage of cardiac dysfunction, even though we could not reveal significant correlations between survival rate and changed strategies associated with ECMO. CONCLUSION: Mechanical circulatory support has played a critical role and has had a dramatic effect on survival in patients with medically intractable heart failure, particularly in recent years. Meticulous monitoring of acid-base status, laboratory findings, and early and liberal applications are recommended to improve outcomes without critical complication rates, particularly in neonates with single ventricle physiology.
Acidosis ; Bilirubin ; Cardiac Output, Low* ; Creatinine ; Critical Care* ; Extracorporeal Membrane Oxygenation ; Heart Defects, Congenital ; Heart Failure ; Heart Transplantation ; Heart-Assist Devices ; Humans ; Infant, Newborn ; Intensive Care Units* ; Lactic Acid ; Liver ; Mortality ; Oxygen ; Oxygenators ; Physiology ; Resuscitation ; Retrospective Studies ; Risk Factors ; Survival Rate ; Survivors

The Rastelli operation has been a standard procedure for repairing complete transposition of the great arteries combined with a ventricular septal defect and pulmonary stenosis. Yet this procedure has several shortcomings, including the risk of incurring left ventricular outflow tract obstruction on long-term follow-up. In this regard, aortic translocation has recently been regarded as a potent alternative to Rastelli's operation. We report here on a case of complete transposition of the great arteries that was combined with an inlet-extended perimembranous ventricular septal defect and pulmonary stenosis in a 2-year-old boy. All the problems were successfully repaired using the aortic translocation technique. Postoperative echocardiography showed a straight and wide left ventricular outflow tract.
Arteries ; Echocardiography ; Follow-Up Studies ; Heart Septal Defects, Ventricular ; Preschool Child ; Pulmonary Valve Stenosis ; Transposition of Great Vessels