전안부 빛간섭단층촬영으로 측정한 방수유출장치 매립에 사용되는 심낭막 이식재의 두께 비교

강민구,서재신,이윤곤,황영훈 대한안과학회 2020 대한안과학회지 Vol.61 No.5

Purpose: To compare the thickness of the processed pericardial patch graft for glaucoma implant tube coverage using anterior segment optical coherence tomography (AS-OCT). Methods: Thicknesses of seven samples of two pericardial patch grafts (Tutoplast pericardium, IOP Inc, Costa Mesa, CA, USA; pericardium LYO, DCI Donor Services, Inc., Nashville, TN, USA) were measured using AS-OCT (CASIA2, Tomey Corporation, Nagoya, Japan). The thickness of each sample was measured at the center and eight points with 45-degree angular distance, 2 mm from the center. The thickness was measured using AS-OCT program tools. Results: The median thicknesses were 219 μm for Tutoplast pericardium and 157 μm for pericardium LYO. Tutoplast pericardium was significantly thicker than pericardium LYO (p = 0.001); pericardium LYO had a wider interquartile range within each sample, compared to Tutoplast pericardium (p = 0.017). Conclusions: The thickness of the Tutoplast pericardium was greater and less variable than that of the pericardium LYO. These findings should be considered when choosing processed pericardium for coverage of glaucoma implants. 목적: 녹내장 방수유출장치 매립에 사용되는 두 가지 종류의 심낭막 이식재의 두께를 빛간섭단층촬영으로 측정하여 비교한다. 대상과 방법: 두 종류의 심낭막 이식재(Tutoplast pericardium, IOP Inc., Costa Mesa, CA, USA) 및 Pericardium LYO, DCI Donor Services, Inc, Nashville, TN, USA)의 표본을 각각 7개씩 준비하여 전안부 빛간섭단층촬영계(CASIA2, Tomey Corporation, Nagoya, Japan)를 이용하여 두께를 측정하였다. 측정 위치는 표본의 중심과 중심으로부터 반지름 2 mm인 원을 기준으로 45° 간격 8지점이고, 각 지점의 두께는 전안부 빛간섭단층촬영계에 내장된 두께 측정 도구를 이용하여 측정하였다. 결과: Tutoplast pericardium의 두께는 중위값 217 μm, Pericardium LYO의 두께는 중위값 154 μm였다. 두 군의 두께를 비교했을때 Tutoplast pericardium이 Pericardium LYO보다 유의하게 더 두꺼웠고(p=0.001), 각 표본 내의 측정치 사분위수 범위를 비교했을때 Pericardium LYO가 Tutoplast pericardium보다 더 컸다(p=0.017). 결론: Tutoplast pericardium이 Pericardium LYO보다 두께가 더 두껍고 균일한 두께를 보였다. 방수유출장치삽입술 중 심낭막 이식재를 이용할 경우, 이러한 특성을 고려하는 것이 도움이 될 것으로 생각한다.

Changes of the Structural and Biomechanical Properties of the Bovine Pericardium after the Removal of α-Gal Epitopes by Decellularization and α-Galactosidase Treatment

남진혜,최선영,성시찬,임홍국,박성식,김수환,김용진 대한흉부외과학회 2012 Journal of Chest Surgery (J Chest Surg) Vol.45 No.6

Background: Bovine pericardium is one of the most widely used materials in bioprosthetic heart valves. Immunologic responses have been implicated as potential causes of limited durability of xenogenic valves. This study aimed to determine the effectiveness of decellularization and α-galactosidase (α-gal) to remove major xenoreactive antigens from xenogenic tissues. Materials and Methods: Recombinant Bacteroides thetaiotaomicron (B. thetaiotaomicron) α-gal or decellularization, or both were used to remove α-gal from bovine pericardium. It was confirmed by α-gal-bovine serum albumin-based enzyme-linked immunosorbent assay (ELISA), high-performance anion exchange chromatography, flow cytometry, 3,3’-diaminobenzidine-staining, and lectin-based ELISA. The mechanical properties of bovine pericardium after decellularization orα-gal treatment were investigated by tests of tensile-strength, permeability, and compliance. Collagen fiber rearrangement was also evaluated by a 20,000× transmission electron microscope (TEM). Results: Recombinant B. thetaiotaomicron α-gal could effectively remove α-gal from bovine pericardium B. thetaiotaomicron (0.1 U/mL, pH 7.2) while recombinant human α-gal removed it recombinant human α-gal (10 U/mL, pH 5.0). There was no difference in the mechanical properties of fresh and recombinant α-gal-treated bovine pericardium. Furthermore, the TEM findings demonstrated that recombinant α-gal made no difference in the arrangement of collagen fiber bundles with decellularization. Conclusion: Recombinant B. thetaiotaomicron α-gal effectively removed α-gal from bovine pericardium with a small amount under physiological conditions compared to human recombinant α-gal, which may alleviate the harmful xenoreactive immunologic responses of α-gal. Recombinant α-gal treatment had no adverse effects on the mechanical properties of bovine pericardium.

Detoxification of Glutaraldehyde Treated Porcine Pericardium Using L-arginine & NABH₄

김관창,Soo-Hwan Kim,김용진 대한흉부외과학회 2011 Journal of Chest Surgery (J Chest Surg) Vol.44 No.2

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 NaBH₄, 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℃). An interim step of ethanol (80%; 1 day at room temperature) or L-lysine (0.1 M; 2 days at 37℃) or L-arginine (0.1 M; 2 days at 37℃)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 NaBH4 pretreatment (1.81±0.39 kgf/5 mm p=0.001,0.30±0.08 mm p<0.001) significantly increased tensile strength and thickness compared with the control (0.53±0.34kgf/5 mm, 0.10±0.02 mm). In a thermal stability test, L-arginine and NaBH₄pretreatment (84.25±1.12oC, p=0.023)caused a significant difference from the control (86.25±0.00℃). L-lysine and NaBH4 pretreatment (183.8±42.6 ug/mg, p=0.804), and L-arginine and NaBH₄pretreatment (163.3±27.5 ug/mg, p=0.621) did not significantly inhibit calcification compared to the control (175.5±45.3 ug/mg), but ethanol and NaBH₄pretreatment did (38.5±37.3 ug/mg,p=0.003). Conclusion: The combined pretreatment using L-arginine and NaBH₄after 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. NaBH₄pretreatment seemed to decrease the calcification of porcine pericardium fixed with GA, but only with ethanol.

심막의 영상 소견

이배영 대한영상의학회 2020 대한영상의학회지 Vol.81 No.2

The clinical manifestation of pericardial disease is similar to that of coronary artery disease and aortic disease. Therefore, a timely and accurate diagnosis is necessary. The pericardium is a 2-layered membrane that envelops the heart and great vessels, and there are numerous anatomic variations and pathologic conditions. Large or unusually located pericardial recesses can be easily mistaken for abnormal findings. Additionally, primary pericardial diseases resulting from infections, tumors, and injuries are possible; further, diseases can quickly spread along the pericardium. Echocardiography is generally the first imaging tool used to evaluate the pericardium. However, it has limited windows and poor resolution. Besides, the evaluation of postoperative echocardiography is sometimes limited. Currently, CT and MR imaging are useful for evaluating pericardial diseases. Detailed knowledge of the pericardium is important for interpreting the images and clinical results. 심막 질환은 응급질환인 관상동맥, 대동맥 질환과 증상이 비슷하여 빠른 감별이 중요하다. 심막은 두겹으로 된 막으로서 다양한 해부학적 변이와 질환이 있다. 크거나 비전형적인 위치를보이는 심막의 오목(recess)은 이상 소견으로 오인될 수도 있다. 심막에는 감염이나 종양 같은 질환이 생기며 또한 주변에서 생기는 이러한 질환의 전파경로가 될 수 있다. 심막을 평가하는데 있어 심초음파가 일차적인 검사방법이나 해상도가 떨어지고 주변의 폐나 뼈에 의한음창이 제한될 수 있으며 수술 후 평가가 힘든 경우가 많다. 이때 CT나 MR에 의한 영상평가가 유용한 경우가 많아 검사가 점점 늘어나고 있다. 심막의 형태와 질환에 대한 지식 및 영상소견에 대한 이해는 환자 치료에 중요하다.

Incidentally Detected Pericardial Defect in a Patient with Pneumothorax as Confirmed on Video-Assisted Thoracoscopic Surgery

조현우,강은주,김문성,정상석,이기남 대한영상의학회 2021 대한영상의학회지 Vol.82 No.3

Congenital defects of the pericardium, which are generally asymptomatic, are rare disorders characterized by complete or partial absence of the pericardium. Here, we report a rare case of a 19-year-old male who was incidentally diagnosed with congenital absence of the left pericardium during examination for symptoms of pneumothorax. Chest radiography and CT revealed a collapsed left lung without any evidence of trauma, no unusual findings of free air spaces along the right side of the ascending aorta, heart shifted toward the left side of the thorax, and a shallow chest. Subsequent thoracoscopy confirmed the absence of the left pericardium and displacement of the heart toward the left thoracic cavity. We further discuss the correlation between radiologic images and surgical findings of a congenital pericardial defect associated with spontaneous pneumothorax.

계면활성제 전처치 및 아미노산 후처치의 병행처치가 우심낭 석회화 완화에 미치는 영향

원태희,장지원,유지영,안재호 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.11

Background: Bovine pericardium treated with glutaraldehyde(GA) is one of the most popular prosthetic materials. However, its late calcific degeneration after implantation results in early failure of the prosthesis. Therefore, we investigated the effects of combined treatment with sodium dodecyl sulfate(SDS) and glutamate on calcific degeneration of GA treated bovine pericardium. Material and Method: Sixty square-shaped pieces of bovine pericardia were fixed in 0.625% GA solution with 4g/L MgCl2.6H2O as a control group (group 1). Sixty pieces pretreated with 1% SDS (group 2) and sixty pieces posttreated with 8% glutamate (group 3) were also fixed in the same GA solution. Sixty pieces pretreated with 1% SDS and posttrated with 8% glutamate were also fixed in the same GA solution (group 4). After 1 month of fixation, the pieces were implanted into the belly of sixty Sprague-Dawley rat subdermally and were extracted 1 month, 2 months and 3 months after the implantation. With an atomic absorption spectrophotometry, we measured the calcium amount deposited. Result: The calcium deposition in 1 month was 2.01$\pm$0.13 mg/g in group 1, 1.45$\pm$0.31 mg/g in group 2, 2.49$\pm$0.15 mg/g in group 3 and 0.75$\pm$0.27 mg/g in group 4. In 2 months, it was 3.57$\pm$0.15 mg/g in group 1, 0.98$\pm$0.30 mg/g in group 2, 3.46$\pm$0.12 mg/g in group 3, and 1.48$\pm$0.39 mg/g in group 4, and 5.45$\pm$0.42 mg/g in group 1, 2.43$\pm$0.53 mg/g in group 2, 4.20$\pm$0.55 mg/g in group 3, and 1.02$\pm$0.27 mg/g in group 4 in 3 months. The calcium depositions in group 2 and 4 were less than those of group 1 and 3 in 1 month 2, months, and 3 months(p<0.01). The calcium depositions in group 1, 2 and 3 increased with time. However, they remained unchanged in group 4, which was statistically significant(p<0.01). Conclusion: Pretreatment with SDS is effective in reducing calcification of GA treated bovine pericardium, and the combined method of pretreatment with SDS and posttreatment with glutamate was more effective than the other methods.

Bladder Reconstruction Using Bovine Pericardium in a Case of Enterovesical Fistula

문성진,김대희,조정기,정재훈,이주용,박성열,김용태,박훤겸,최홍용,문홍상 대한비뇨의학회 2011 Investigative and Clinical Urology Vol.52 No.2

The use of graft materials in bladder mucosa has been examined in animal models, but debate exists over which materials are effective. Intestine has been used as a substitute in augmentation cystoplasty for patients with neuropathic bladder, but serious adverse effects of the operation have occurred in some instances. We report a case of a successful repair of an enterovesical fistula by use of bovine pericardium. The patient has remained well for 2.5 years. We suggest that bovine pericardium may be a suitable option as a bladder substitute.

Bovine pericardium을 이용한 기관협착의 치험예

김부연,이교준,신화균,이응석 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.4

This case describes a tracheal stenosis complicated by endobronchial truberculosis. A 50-year-old female with progressive dyspnea was referred to us for the management of long segmental tracheal stenosis. Treatment modalities for tracheal stenosis include open surgical resectin and reconstruction, mechanical dilation, laser resection, and placement of an airway prosthesis. The following is a report of a successful treatment of a long segmental tracheal stenosis through a tracheal augmentation and the use of al Bovine pericardium. This technique may provide a relief from tracheal stenosis.

동종조직이식술시 전염성질환의 이환가능성에 대한 고찰 II: 동종연조직

이은영,김경원,엄인웅,Lee, Eun-Young,Kim, Kyoung-Won,Um, In-Woong 대한악안면성형재건외과학회 2007 Maxillofacial Plastic Reconstructive Surgery Vol.29 No.3

Implantation of allografts has increased widely with not only the availability of many allogenic bone but also allogenic soft tissues. The aim of tissue banking is to provide surgeons with safe tissues compatible with their intended clinical application. The incidence of tissue transplant-transmitted infection is unknown and can only be inferred from prospective studies. The possibility of donor-to-recipient disease transmission through soft tissue transplantation can be considered by reviewing the risk associated with other transplanted hard tissues. Viral, bacterial, and fungal infections have been transmitted via transplantation of soft tissue allografts such as skin, cornea, dura, pericardium. fascia lata, and heart valves. Corneas have transmitted rabies, Creutzfeldt-Jakob disease (CJD), hepatitis B (HBV), cytomegalovirus (CMV), herpes simplex virus (HSV), bacteria, and fungi. Heart valves have been implicated in transmitting tuberculosis, hepatitis B. HIV-1 and CMV. CJD has been transmitted by dura and pericardium transplants. Skin has transmitted CMV, bacteria, and fungi. Cadaveric skin, pericardium, dura, and fascia lata have been used in dental patients with intra-oral soft tissue injuries and GBR. This study is review of the considering transmission of infectious disease in allogenic soft tissues and guidelines of reducing the risk. Prior to use, many tissues are exposed to antibiotics, disinfectants, and sterilants, which further reduce or remove the risk of transmitted disease. Because some soft tissue grafts cannot be subjected to sterilization steps, the risk of infectious disease transmission remains and thorough donor screening and testing is especially important.

띠 모양의 윤상 심막 석회화 452 -1예 보고-

조양현,김학제,류세민,조종호,손영상,최영호,김요한 대한흉부외과학회 2004 Journal of Chest Surgery (J Chest Surg) Vol.37 No.5

We report a case of a 46-year-old woman whose right ventricular out-flow tract was moderately obstructed by a heavily calcified pericardial ring. It was passing over the base of pulmonary artery and mid-portion of left ventricle but the other parts of the pericardium was mildly fibrotic. The pericardium and calcified ring were completely removed under cardiopulmonary bypass. The patient was recovered uneventfully and we could not find the specific cause of calcified pericardial ring. 호흡곤란을 주소로 46세 여자 환자가 내원하여, 윤상 심막 석회화에 의한 좌심실 이완장애와 우심실 유출로 협착을 진단받았다. 수술장 소견상 윤상으로 심하게 석회화 띠가 폐동맥 기시부와 좌심실 중간 부위를 지나고 있었으며 이외의 심막은 경도의 섬유화만이 관찰되었다. 수술은 체외순환하에 시행하였고 환자는 특별한 합병증 없이 회복되었으며 심막 석회화의 원인은 찾을 수 없었다.