Cette étude a été financée par la «Deutsche Forschungsgemeinschaft» (DFG). K. Schleimer a été soutenue par la Lise Meitner bourse du Ministère de la Science et de la Recherche de NRW. Nous tenons à remercier Mme Marie-Jeanne Blümich pour son excellent aide à l&#39;édition. Dr Maria Kokozidou a été financée par Fresenius 2011_A61.

1. animaux d&#39;expérimentation <ol><li> Obtenir une approbation du comité d&#39;éthique local pour toutes les expériences qui seront effectuées, conformément aux directives de protection des animaux de FELASA (K 40, 17/99). </li><li> Utilisez rats Lewis mâles disponibles à l&#39;achat de n&#39;importe quel éleveur commercial (par exemple, Charles River Wiga GmbH, Sulzfeld, Allemagne). Ici, 224 animaux (112 donateurs, 112 bénéficiaires) ont été utilisés pour effectuer 112 transplantations. Les bénéficiaires ont été sacrifiés à 6 semaines après l&#39;opération. Au moment de l&#39;opération, les animaux doivent peser 250-350 g. </li><li> Gardez les animaux dans les chambres à température contrôlée avec un accès libre à la nourriture et de l&#39;eau. </li></ol> 2. anesthésie et la préparation opérationnelle <ol><li> Placer le rat dans une boîte en plexiglas connecté à l&#39;appareil d&#39;anesthésie avec un débit d&#39;oxygène de 1 L / min, et un vaporisateur isofluorane avec 5% de gaz anesthésiant pour induire une anesthésie. Maintenir l&#39;anesthésie à 1,5% isofluorane. </li><li> Placez les ratsdécubitus dorsal sur une plaque chauffante. </li><li> Retirez la fourrure de l&#39;abdomen avec une crème d&#39;épilation. </li><li> Préparer un champ opératoire stérile comme suit: Utilisez un désinfectant pour nettoyer la surface de travail. Pour la désinfection de l&#39;utilisation du site de l&#39;incision de chlorhexidine premier, second alcool et, enfin, une solution de lavage (par exemple, 70% de chlorhexidine et de l&#39;alcool isopropylique). Porter une blouse chirurgicale jetable et des gants chirurgicaux. </li><li> Utiliser des instruments de microchirurgie stériles. </li><li> Utiliser un microscope d&#39;opération en 12-20 fois grossissement. </li></ol> 3. procédure chirurgicale <ol><li> fonctionnement des bailleurs de fonds Préparation <ol><li> Effectuez une laparotomie médiane et une résection du lobe latéral gauche et le lobe médian de la greffe comme décrit par Higgins. 14 </li><li> Puis préparer le pédicule hépatique. Tout d&#39;abord ligaturer le canal biliaire afin d&#39;induire la congestion et la dilatation de la petite voie biliaire. Puis ligaturer et transect le gastroduodenal veine et de l&#39;artère. Ensuite, isoler le tronc cœliaque et l&#39;artère hépatique commune et transect l&#39;artère gastrique gauche et l&#39;artère splénique. Inciser la voie biliaire congestionné, et introduire un stent G-20 dedans. Le positionnement du stent doit assurer le drainage de l&#39;ensemble du système de la voie biliaire hilaire. Transect de la voie biliaire distale de l&#39;endoprothèse. </li><li> Isoler le segment-hépatique de la veine cave juste au-dessus de la veine rénale droite. Perfusion </li><li> Après la ligature de l&#39;aorte au-dessus du tronc coeliaque, serrer la veine porte et inciser. Introduire le cathéter de perfusion (14 G) dans la veine porte, et effectuer la perfusion avec 30 ml d&#39;histidine-tryptophane-cétoglutarate (HTK) -solution (12 cm H2O, 4 ° C). </li><li> Couper le diaphragme et la veine cave sus-hépatique pour permettre le perfusat de s&#39;écouler. </li><li> Exciser le tronc cœliaque avec un correctif de l&#39;aorte et le rincer avec une solution histidine-tryptophane-cétoglutarate. Explantation </li><li> Transect la veine cave-hépatique droite au-dessus de la veine rénale droite. </li><li> Ensuite, placer un stent avec un diamètre de 0,3 mm dans la veine porte et le fixer avec une ligature. Au cours de l&#39;opération suivante, la veine porte est artérialisée via l&#39;artère rénale droite. Transect de la veine porte distale de l&#39;endoprothèse. </li><li> Après la ligature de la veine cave sus-hépatique, transect ensemble avec un brassard de la membrane. </li><li> Explanter la greffe et le stocker dans histidine-tryptophane-cétoglutarate (HTK) -solution à 4 ° C dans un sac en plastique sur la glace. Sutures Lieu de coin (8-0) de Ethilon dans la veine cave-hépatique. </li></ol></li><li> opération de bénéficiaire <ol><li> Effectuez une laparotomie médiane et préparer la veine cave-hépatique. Puis isoler l&#39;artère rénale droite et l&#39;uretère, ligaturer l&#39;uretère et transect il. Fixer l&#39;artère rénale droite à son origine, puis ligaturer la veine rénale droite. Puis, après sectionnement des deux renavires nales, effectuer la néphrectomie. Par la suite, de réduire l&#39;artère rénale droite, rincer avec une solution saline héparine (40 UI d&#39;héparine / ml de solution saline). </li><li> Transect la veine rénale droite proximale de la ligature après serrage proximale et distale de la veine cave-hépatique pour créer un ovale lumière dans la veine cave-hépatique. Rincer la veine cave avec une solution saline héparine. Implanter le greffon dans la région rénale droite de l&#39;abdomen du destinataire. </li><li> Anastomoser-hépatique fin à côté de veine cave du donateur à la recipient`s veine cave par un surjet 8-0 Ethilon. </li><li> Après rinçage avec une solution d&#39;héparine / solution saline, introduire le stent dans la veine porte dans l&#39;artère rénale droite (figure 3). Connectez la veine porte et l&#39;artère rénale avec 2 points (8-0) Ethilon. Fixer le stent reliant dans l&#39;artère rénale avec une ligature (soie noire tressée 7-0). </li><li> Pour permettre la reperfusion, retirez d&#39;abord la pince artérielle, alors à la foispinces veineux (figure 4). </li><li> Préparer l&#39;aorte, puis placez une extrémité proximale et distale microCLAMP et inciser l&#39;aorte à droite entre les deux pinces. Effectuer une anastomose bout à l&#39;autre entre l&#39;aorte et le tronc cœliaque du donateur, en utilisant une pièce de l&#39;aorte, par un surjet 10-0 de Ethilon. </li><li> Insérez la voie biliaire dans le duodénum: Appliquer une suture pursestring dans la paroi duodénale, faire une petite incision dans la paroi duodénale en plein milieu de la pursestring. Introduire la voie biliaire stent dans le duodénum, ​​et serrer la suture pursestring. Enfin, maintenez le duodénum et le canal biliaire étroitement avec deux points (8-0) Ethilon (figure 5). </li><li> Puis effectuer une résection subtotale du foie natif, d&#39;abord décrit par Emond et al. pour imiter une insuffisance hépatique aiguë. 7 </li><li> Fixer la veine cave sus-hépatique du greffon, avec un brassard de diaphragme, de la paroi abdominale latérale de la recipient 4-0 Vicryl suture. Rincer l&#39;abdomen avec une solution saline (figure 6). </li><li> Pour la couche musculaire utiliser un surjet 4-0 Vicryl et pour cutanés un surjet 3-0 Vicryl. </li></ol></li></ol> 4. rétablissement et de gestion post-opératoire <ol><li> Laissez les animaux se remettre de l&#39;anesthésie sous une lampe chauffante infrarouge. </li><li> Injecter la buprénorphine à la dose de 0,03-0,05 mg / kg de poids corporel sc tous les 8-12 heures pendant 2 jours. </li><li> Examiner les animaux concernant l&#39;état général et des signes de maladie ou d&#39;infection. </li></ol> 5 Calcul de la maternelle initiale poids du foie Calculer le poids du foie natif initial de la manière suivante: soustraire le poids des lobes du foie réséqués à partir de la masse du foie intégral (2,66% du poids du corps (cette valeur avec un écart-type de +/- 0,49% a été déterminée dans des expériences précédentes avec n = 80 animaux de même souche et unge)) 15.

<ol>
	<li>Boudjema, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Auxiliary+liver+transplantation+for+fulminant+and+subfulminant+hepatic+failure.">Auxiliary liver transplantation for fulminant and subfulminant hepatic failure.</a> Transplantation. 59, 218-223 (1995).</li><li>Boudjema, K., Jaeck, D., Sim&#233;oni, U., Bientz, J., Chenard, M. P., Brunot, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Temporary+auxiliary+liver+transplantation+for+subacute+liver+failure+in+a+child.">Temporary auxiliary liver transplantation for subacute liver failure in a child.</a> The Lancet. 342, 778-779 (1993).</li><li>Chenard-Neu, M. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Auxiliary+liver+transplantation:+Regeneration+of+the+native+liver+and+outcome+in+30+patients+with+fulminant+hepatic+failure+-+a+multicenter+European+study.">Auxiliary liver transplantation: Regeneration of the native liver and outcome in 30 patients with fulminant hepatic failure - a multicenter European study.</a> Hepatology. 23, 1119-1127 (1996).</li><li>Gubernatis, G., Pichlmayr, R., Kemnitz, J., Gratz, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Auxiliary+partial+orthotopic+liver&#8211;transplantation+(APOLT)+for+fulminant+hepatic+failure:+first+successful+case+report.">Auxiliary partial orthotopic liver&#8211;transplantation (APOLT) for fulminant hepatic failure: first successful case report.</a> World J Surg. 15, 660-666 (1991).</li><li>Erhard, J., Lange, R., Giebler, R., Rauen, U., de Groot, H., Eigler, F. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Arterialization+of+the+portal+vein+in+orthotopic+and+auxiliary+liver+transplantation.">Arterialization of the portal vein in orthotopic and auxiliary liver transplantation.</a> Transplantation. 60, 877-879 (1995).</li><li>Erhard, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Auxiliary+liver+transplantation+with+arterialization+of+the+portal+vein+for+acute+hepatic+failure.">Auxiliary liver transplantation with arterialization of the portal vein for acute hepatic failure.</a> Transpl Int. 11, 266-271 (1998).</li><li>Emond, J., Capron-Laudereau, M., Meriggi, F., Bernuau, J., Reynes, M., Houssin, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Extent+of+Hepatectomy+in+the+rat.">Extent of Hepatectomy in the rat.</a> Eur Surg Res. 21, 251-259 (1989).</li><li>Mas, A., Rode`s, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fulminant+hepatic+failure.">Fulminant hepatic failure.</a> Lancet. 349, 1081-1085 (1997).</li><li>Terpstra, O. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Auxiliary+liver+grafting:+a+new+concept+in+liver+transplantation.">Auxiliary liver grafting: a new concept in liver transplantation.</a> The Lancet. 342, 758 (1993).</li><li>Terpstra, O. T., Reuvers, C. B., Schalm, S. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Auxiliary+heterotopic+liver+transplantation.">Auxiliary heterotopic liver transplantation.</a> Transplantation. 45, 1003-1007 (1988).</li><li>Schleimer, K., Lange, R., Rauen, U., Erhard, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Auxiliary+liver+transplantation+in+acute+liver+failure+in+the+rat+-+an+illustrated+description+of+a+new+surgical+approach.">Auxiliary liver transplantation in acute liver failure in the rat - an illustrated description of a new surgical approach.</a> Langenbecks Arch Surg. 384 (2), 204-208 (1999).</li><li>Schleimer, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Physiologic+microcirculation+of+the+heterotopically+transplanted+rat+liver+with+portal+vein+arterialization+depending+on+optimal+stent+diameter.">Physiologic microcirculation of the heterotopically transplanted rat liver with portal vein arterialization depending on optimal stent diameter.</a> Med Sci Monit. 28 (BR140-145), (2006).</li><li>Hong, H. Q., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Study+of+portal+arterialization+with+auxiliary+liver+in+rats.">Study of portal arterialization with auxiliary liver in rats.</a> Hiroshima J. Med. Sci. 40, 29-33 (1991).</li><li>Higgins, G. M., Anderson, R. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Experimental+pathology+of+the+liver.+I--Restoration+of+the+liver+of+the+white+rat+following+partial+surgical+removal.">Experimental pathology of the liver. I--Restoration of the liver of the white rat following partial surgical removal.</a> Arch. Path. 12, 186-202 (1931).</li><li>Schleimer, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Auxiliary+liver+transplantation+with+flow-regulated+portal+vein+arterialization+offers+a+successful+therapeutic+option+in+acute+hepatic+failure--investigations+in+heterotopic+auxiliary+rat+liver+transplantation.">Auxiliary liver transplantation with flow-regulated portal vein arterialization offers a successful therapeutic option in acute hepatic failure--investigations in heterotopic auxiliary rat liver transplantation.</a> Transpl Int. 19 (7), 581-588 (2006).</li><li>Lee, S., Edgington, T. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Liver+transplantation+in+the+rat.">Liver transplantation in the rat.</a> Surg. Forum. 17, 220-222 (1966).</li><li>Hess, F., Willemen, A., Jerusalem, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Auxiliary+liver+transplantation+in+the+rat,+influence+of+the+condition+of+the+recipient's+liver+on+the+fate+of+the+graft.">Auxiliary liver transplantation in the rat, influence of the condition of the recipient's liver on the fate of the graft.</a> Eur. Surg. Res. 9, 270-279 (1977).</li><li>Aguirrezabalaga, J., Arnal, F., Marini, M., Centeno, A., Fernandez-Selles, C., Rey, I., Gomez, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Auxiliary+liver+transplantation+with+portal+arterialization+in+the+rat:+description+of+a+new+model.">Auxiliary liver transplantation with portal arterialization in the rat: description of a new model.</a> Microsurgery. 22, 21-26 (2002).</li><li>Palmes, D., Dietl, K. H., Drews, G., Holzen, J. P., Spiegel, H. U. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Auxiliary+partial+orthotopic+liver+transplantation:+treatment+of+acute+liver+failure+in+a+new+rat+model.">Auxiliary partial orthotopic liver transplantation: treatment of acute liver failure in a new rat model.</a> Langenbecks Arch Surg. (386), 534-541 (2002).</li><li>Schleimer, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Improved+microcirculation+of+a+liver+graft+by+controlled+portal+vein+arterialization.">Improved microcirculation of a liver graft by controlled portal vein arterialization.</a> J Surg Res. 116 (2), 202-210 (2004).</li><li>Schleimer, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Portal+hyperperfusion+causes+disturbance+of+microcirculation+and+increased+rate+of+hepatocellular+apoptosis:+investigations+in+heterotopic+rat+liver+transplantation+with+portal+vein+arterialization.">Portal hyperperfusion causes disturbance of microcirculation and increased rate of hepatocellular apoptosis: investigations in heterotopic rat liver transplantation with portal vein arterialization.</a> Transplant Proc. 38 (3), 725-729 (2006).</li></ol>

Tous les auteurs déclarent aucun conflit d&#39;intérêts.

La première transplantation hétérotopique auxiliaire de foie de rat a été décrite par Lee et al., 16 en 1966, suivi par Hess. 17 La veine porte du greffon a été anastomosée avec la veine porte du destinataire. Au cours de cette procédure, l&#39;alimentation en sang de la veine porte vers le foie natif est compromise. En 1991, Hong effectuée HALT avec le PVA par l&#39;artère iliaque du destinataire. 13 Sans régulation du débit sanguin po...

Insuffisance hépatique aiguë pose un grave problème dans la médecine clinique conduisant à un taux de mortalité de 60-80%. 8 En cas d&#39;insuffisance hépatique aiguë, la transplantation hépatique auxiliaire est une thérapie alternative prometteuse pour combler la phase aiguë. Le foie natif est laissée à régénérer et à la suite de la régénération, les médicaments immunosuppresseurs peuvent être interrompues. En conséquence, la greffe devient atrophique. Cependant la technique opératoire de transplantation hépatique auxiliaire est encore discutée. 1-3 Dans ce contexte, Terpstra a signalé le manque d&#39;espace pour la greffe, le sang portail voler phénomène et le problème de la congestion veineuse et le drainage 9-10 la veine porte du donneur. a été anastomosée fin à côté de la veine porte du destinataire. Cela a abouti à la concurrence de flux portail entre le greffon et le foie natif et dans la thrombose de la veine porte. La plupart de ces problèmes techniques peuvent être évitées par l&#39;utilisation de la méthode APOLT (orthotopic implantation des segments auxiliaires). 4 Cependant, cette méthode nécessite des résections extensives à la fois du foie natif et le greffon. 4 En 1998, Erhard et son équipe ont développé la transplantation hétérotopique auxiliaire du foie (HALT) utilisant artérialisation de la veine porte (PVA) (Figure 1 ). Le hile et de la veine porte du foie natif sont respectées avec l&#39;utilisation de cette méthode. Qui n&#39;épargne le destinataire de effets secondaires indésirables tels que la thrombose de la veine porte et de sang portail voler phénomène, qui pourrait perturber la reprise de foie natif. En outre, aucun des résections extensives du foie du foie natif et greffe sont nécessaires pour cette méthode, avec pour conséquence moins de saignements et plus reste la masse totale du parenchyme hépatique pour combler (greffe) et de régénération (de foie natif). Cette technique a montré des résultats prometteurs cliniques initiaux. 5-6 Le but de ce travail expérimental a été le développement d&#39;une technique de HALT avec artérialisation de la veine porte enle rat à des fins de recherche (figure 2). Dans les expériences préliminaires que nous n&#39;avons pas pris en considération la réglementation de la circulation sanguine du portail artérialisé veine, ce qui a entraîné de la congestion de la greffe transplanté après reperfusion et une hémorragie massive de la capsule du foie. 11 Depuis lors, le flux sanguin dans la veine porte artérialisé a été régulée par un stent ayant un diamètre intérieur de 0,3 mm et une longueur de 8 mm. Des expériences pilotes ont montré que le diamètre du stent de 0,3 mm donne un flux de sang en moyenne dans la veine artérialisé qui est dans la fourchette haute physiologique (1,7 +/- 0,4 ml / min / g du poids du foie). 12 Nos résultats sans régulation de la circulation sanguine corrélation avec les résultats de Hong, qui a effectué HALT avec le PVA par l&#39;artère iliaque du destinataire. 13 Dans ses expériences sans régulation du débit sanguin portal massive et congestions sinusoïde s&#39;est produite. Le but de notre vidéo est de dl&#39;étape de emonstrate par cette étape de la technique chirurgicale ne.w expérimental chez le rat. À long terme, la technique proposée peut être utilisée dans les études sur la régénération du foie et de la concurrence inter-foie et portail artérialisation de veine, portail hyperperfusion de la veine et la régulation du débit sanguin portal.

<table border="0" cellpadding="0" cellspacing="0" width="573">
	<tbody>
		<tr height="41">
			<td height="41" style="height:41px;width:216px;">Braided Silk black 7-0&#160;</td>
			<td style="width:71px;">Ethicon Products</td>
			<td style="width:119px;">892100</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="41">
			<td height="41" style="height:41px;width:216px;">Vicryl 3-0</td>
			<td style="width:71px;">Ethicon Products</td>
			<td style="width:119px;">J285G</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="41">
			<td height="41" style="height:41px;width:216px;">Vicryl 4-0</td>
			<td style="width:71px;">Ethicon Products</td>
			<td style="width:119px;">J284G</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="41">
			<td height="41" style="height:41px;width:216px;">Ethilon 8-0</td>
			<td style="width:71px;">Ethicon Products</td>
			<td style="width:119px;">1714G</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="41">
			<td height="41" style="height:41px;width:216px;">Ethilon 10-0</td>
			<td style="width:71px;">Ethicon Products</td>
			<td style="width:119px;">7770G</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Vasofix safety 14G</td>
			<td style="width:71px;">B Braun</td>
			<td style="width:119px;">2758853</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Vasofix safety 20G</td>
			<td style="width:71px;">B Braun</td>
			<td style="width:119px;">2758818</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="201">
			<td height="201" style="height:201px;width:216px;">2 French (.012&#8221;/0.3mm ID x .025&#8221;/0.6mm OD) x 24&#8221;/60cm polyurethane catheter</td>
			<td style="width:71px;">Access technologies a division of Norfolk Medical, Inc., Illinois, USA</td>
			<td style="width:119px;">CNC-2P</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="119">
			<td height="119" style="height:119px;width:216px;">HTK solution,</td>
			<td rowspan="2" style="width:71px;">Dr. Franz K&#246;hler Chemie GmbH, Alsbach-H&#228;hnlein, Germany</td>
			<td rowspan="2" style="width:119px;"></td>
			<td rowspan="2" style="width:167px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Custodiol</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:216px;">Isofluorane 5 %</td>
			<td style="width:71px;"></td>
			<td style="width:119px;"></td>
			<td style="width:167px;">Any genericon</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:216px;">Heparin</td>
			<td style="width:71px;"></td>
			<td style="width:119px;"></td>
			<td style="width:167px;">Any genericon</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:216px;">0.9% saline</td>
			<td style="width:71px;"></td>
			<td style="width:119px;"></td>
			<td style="width:167px;">Any genericon</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:216px;">Buprenorphine</td>
			<td style="width:71px;"></td>
			<td style="width:119px;"></td>
			<td style="width:167px;">Any genericon</td>
		</tr>
	</tbody>
</table>

heterotopic auxiliary rat liver transplantation with flow-regulated portal vein arterialization in acute hepatic failure

Dans aiguë insuffisance hépatique auxiliaire transplantation hépatique est une approche alternative intéressante. L&#39;objectif est de fournir un soutien temporaire jusqu&#39;à ce que le foie natif ne s&#39;est régénéré. 1-3 Le APOLT méthode, l&#39;implantation orthotopique de segments- auxiliaire évite la plupart des problèmes techniques. Cependant, cette méthode nécessite des résections extensives à la fois du foie natif et le greffon. 4 En 1998, Erhard a développé la transplantation hétérotopique auxiliaire du foie (HALT) utilisant artérialisation de la veine porte (PVA) (figure 1). Cette technique a montré des résultats prometteurs cliniques initiaux. 5-6 Nous avons développé un HALT-technique avec débit régulé PVA chez le rat pour examiner l&#39;influence de PVA de débit régulé sur la morphologie et la fonction du greffon (figure 2). Une greffe du foie réduit à 30% de sa taille originale, a été hétérotopique implanté dans la région rénale droite du destinataire après explantation du rein droit.60; La veine cave infra-hépatique de la greffe a été anastomosée à la veine cave-hépatique du destinataire. Le portail artérialisation de la veine du donneur a été réalisée via l&#39;artère rénale droite du destinataire avec la technique du stent. La régulation du flux sanguin de la veine porte artérialisé a été réalisé avec l&#39;utilisation d&#39;un stent ayant un diamètre intérieur de 0,3 mm. Le tronc coeliaque du greffon était de bout en face anastomosée avec l&#39;aorte du receveur et de la voie biliaire a été implantée dans le duodénum. Une résection subtotale du foie natif a été effectuée pour induire une insuffisance hépatique aiguë. 7 De cette manière, 112 transplantations ont été réalisées. Le taux de survie était de 90% périopératoire et le taux de survie à six semaines était de 80%. Six semaines après l&#39;opération, le foie natif régénéré, montrant une augmentation de poids de 2,3 ± 0,8 g à 9,8 ± 1 g. A cette époque, le poids de la greffe a diminué de 3,3 ± 0,8 g à 2,3 ± 0,8 g. </p&gt; Nous avons pu obtenir des résultats prometteurs à long terme en termes de morphologie et la fonction du greffon. HALT avec débit régulé PVA comble fiable insuffisance hépatique aiguë jusqu&#39;à ce que le foie natif régénère.

La durée moyenne de la transplantation est d&#39;environ 150 min. La durée d&#39;ischémie froide était de 64 +/- 7 min, le temps d&#39;ischémie chaude est inférieure à 25 min. Le taux de survie était de 90% périopératoire et le taux de survie à six semaines était de 80%. La perte de 20% est due à une péritonite en raison de stent dislocation et la fuite biliaire (quatre animaux) au cours de la première semaine post-opératoire et en raison de la pneumonie, abcès intra-abdomin...

Watch this Scientific Journal Video about Heterotopic Auxiliary Rat Liver Transplantation With Flow-regulated Portal Vein Arterialization in Acute Hepatic Failure at JoVE.com

Heterotopic Auxiliary Rat Liver Transplantation With Flow-regulated Portal Vein Arterialization in Acute Hepatic Failure

Transplantation hépatique auxiliaire fournit un support temporaire en insuffisance hépatique aiguë, jusqu&#39;à la régénération du foie défaillant. La transplantation hétérotopique auxiliaire du foie (HALT) avec artérialisation de la veine porte (PVA) rend une fonction hépatique suffisante. Nous avons développé une technique analogue chez le rat afin d&#39;examiner l&#39;influence de l&#39;artérialisation de la veine sur la morphologie et la fonction de la greffe.

Hétérotopique auxiliaire Rat Liver Transplantation avec un débit régulé veine porte artérialisation dans l&#39;insuffisance hépatique aiguë

In acute hepatic failure auxiliary liver transplantation is an interesting alternative approach. The aim is to provide a temporary support until the ...

heterotopic-auxiliary-rat-liver-transplantation-with-flow-regulated

Research

JoVE Journal

Medicine

12.6K vues.  University Hospital RWTH Aachen.  Transplantation hépatique auxiliaire fournit un support temporaire en insuffisance hépatique aiguë, jusqu'à la régénération du foie défaillant. La transplantation hétérotopique auxiliaire du foie (HALT) avec artérialisation de la veine porte (PVA) rend une fonction hépatique suffisante. Nous avons développé une technique analogue chez le rat afin d'examiner l'influence de l'artérialisation de la veine sur la morphologie et la fonction de la...

Vidéo: Heterotopic Auxiliary Rat Liver Transplantation With Flow-regulated Portal Vein Arterialization in Acute Hepatic Failure

Surgical Procedures for a Rat Model of Partial Orthotopic Liver Transplantation with Hepatic Arterial Reconstruction

Orthotopic liver transplantation (OLT) in rats using a whole or partial graft is an indispensable experimental model for transplantation research, such as studies on graft preservation and ischemia-reperfusion injury 1,2, immunological responses 3,4, hemodynamics 5,6, and small-for-size syndrome 7. The rat OLT is among the most difficult animal models in experimental surgery and demands advanced microsurgical skills that take a long time to learn. Consequently, the use of this model has been limited. Since the reliability and reproducibility of results are key components of the experiments in which such complex animal models are used, it is essential for surgeons who are involved in rat OLT to be trained in well-standardized and sophisticated procedures for this model.
While various techniques and modifications of OLT in rats have been reported 8 since the first model was described by Lee et al. 9 in 1973, the elimination of the hepatic arterial reconstruction 10 and the introduction of the cuff anastomosis technique by Kamada et al. 11 were a major advancement in this model, because they simplified the reconstruction procedures to a great degree. In the model by Kamada et al., the hepatic rearterialization was also eliminated. Since rats could survive without hepatic arterial flow after liver transplantation, there was considerable controversy over the value of hepatic arterialization. However, the physiological superiority of the arterialized model has been increasingly acknowledged, especially in terms of preserving the bile duct system 8,12 and the liver integrity 8,13,14.
In this article, we present detailed surgical procedures for a rat model of OLT with hepatic arterial reconstruction using a 50% partial graft after ex vivo liver resection. The reconstruction procedures for each vessel and the bile duct are performed by the following methods: a 7-0 polypropylene continuous suture for the supra- and infrahepatic vena cava; a cuff technique for the portal vein; and a stent technique for the hepatic artery and the bile duct.

Orthotopic liver transplantation in rats is an indispensable experimental model for biomedical research. Here we present our surgical procedures for orthotopic rat liver transplantation with hepatic arterial reconstruction using a 50% partial graft.

Interventions chirurgicales pour un modèle de rat de transplantation hépatique orthotopique partielle avec reconstruction artérielle hépatique

Orthotopic liver transplantation (OLT) in rats using a whole or partial graft is an indispensable experimental model for transplantation research, such as ...

Recherche

Médecine

Rat Heterotopic Abdominal Heart/Single-lung Transplantation in a Volume-loaded Configuration

Herein, we describe a novel technique for heterotopic abdominal heart-lung transplantation (HAHLT) in rats. The configuration of the transplant graft involves anastomosis of donor inferior vena cava (IVC) to recipient IVC, and donor ascending aorta (Ao) to recipient abdominal Ao. The right upper and middle lung lobes are preserved and function as conduits for blood flow from right heart to left heart.
There are several advantages to using this technique, and it lends itself to a broad range of applications. Because the graft is transplanted in a configuration that allows for dyamic volume-loading, cardiac function may be directly assessed in vivo. The use of pressure-volume conductance catheters permits characterization of load-dependent and load-independent hemodynamic parameters. The graft may be converted to a loaded configuration by applying a clamp to the recipient&#8217;s infra-hepatic IVC. We describe modified surgical techniques for both donor and recipient operations, and an ideal myocardial protection strategy. Depending on the experimental aim, this model may be adapted for use in both acute and chronic studies of graft function, immunologic status, and variable ventricular loading conditions. The conducting airways to the transplanted lung are preserved, and allow for acute lung re-ventilation. This facilitates analysis of the effects of the mixed venous and arterial blood providing coronary perfusion to the graft.
A limitation of this model is its technical complexity. There is a significant learning curve for new operators, who should ideally be mentored in the technique. A surgical training background is advantageous for those wishing to apply this model. Despite its complexity, we aim to present the model in a clear and easily applicable format. Because of the physiologic similarity of this model to orthotopic transplantation, and its broad range of study applications, the effort invested in learning the technique is likely to be worthwhile.

We describe a novel technique for heterotopic abdominal heart-lung transplantation (HAHLT) in rats. The transplant configuration results in a partially loaded graft circulation, allowing direct functional assessment. This model may be employed for acute or chronic studies of function and immunologic status of the transplanted graft.

Rat Heterotopic abdominale Coeur / Transplantation pulmonaire simple dans une configuration de volume chargé

Herein, we describe a novel technique for heterotopic abdominal heart-lung transplantation (HAHLT) in rats. The configuration of the transplant graft ...

Heterotopic Cervical Heart Transplantation in Mice

The heterotopic cervical heart transplantation in mice is a valuable tool in transplant and cardiovascular research. The cuff technique greatly simplifies this model by avoiding challenging suture anastomoses of small vessels thereby reducing warm ischemia time. In comparison to abdominal graft implantation the cervical model is less invasive and the implanted graft is easily accessible for further follow-up examinations. Anastomoses are performed by pulling the ascending aorta of the graft over the cuff with the recipient&#8217;s common carotid artery and by pulling the main pulmonary artery over the cuff with the external jugular vein. Selection of appropriate cuff size and complete mobilization of the vessels are important for successful revascularization. Ischemia-reperfusion (I/R) injury can be minimized by perfusing the graft with a cardioplegic solution and by hypothermia. In this article, we provide technical details for a simplified and improved cuff technique, which should allow surgeons with basic microsurgical skills to perform the procedure with a high success rate.

The cuff technique shortens and facilitates the model of heterotopic cervical heart transplantation in mice by avoiding technically challenging suture anastomoses of small vessels. The technical details shown in this video paper should allow researches to establish this model in their laboratories.

Heterotopic col de l&#39;utérus chez la souris Transplantation cardiaque

The heterotopic cervical heart transplantation in mice is a valuable tool in transplant and cardiovascular research. The cuff technique greatly simplifies ...

Rat Model of the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) Procedure

Recent clinical data support an aggressive surgical approach to both primary and metastatic liver tumors. For some indications, like colorectal liver metastases, the amount of liver tissue left behind after liver resection has become the main limiting factor of resectability of large or multiple liver tumors. A minimal amount of functional tissue is required to avoid the severe complication of post-hepatectomy liver failure, which has high morbidity and mortality. Inducing liver growth of the prospective remnant prior to resection has become more established in liver surgery, either in the form of portal vein embolization by interventional radiologists or in the form of portal vein ligation several weeks prior to resection. Recently, it was shown that liver regeneration is more extensive and rapid, when the parenchymal transection is added to portal vein ligation in a first stage and then, after only one week of waiting, resection performed in a second stage (Associating Liver Partition and Portal vein ligation for Staged hepatectomy = ALPPS). ALPPS has rapidly become popular across the world, but has been criticized for its high perioperative mortality. The mechanism of accelerated and extensive growth induced by this procedure has not been well understood. Animal models have been developed to explore both the physiological and molecular mechanisms of accelerated liver regeneration in ALPPS. This protocol presents a rat model that allows mechanistic exploration of accelerated regeneration.

Rat Model of the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy ALPPS Procedure

Inducing rapid liver hypertrophy using Associating Liver Partition and Portal vein ligation for a Staged hepatectomy (ALPPS) has been proposed for resection of borderline resectable liver tumors. This model may elucidate mechanisms involved in rapid hypertrophy and allows testing of drugs that promote or block the acceleration of regeneration.

Modèle de rat de la Partition du foie associant et la ligature de la veine porte pour la procédure de mise en scène une hépatectomie (ALPPS)

Recent clinical data support an aggressive surgical approach to both primary and metastatic liver tumors. For some indications, like colorectal liver ...

Re-Arterialized Rat Partial Liver Transplantation with an in vivo Vessel-Oriented 70% Hepatectomy

Split liver transplantation and living liver donor liver transplantation were developed in the clinic to utilize liver organs in a more efficient manner. To better understand the mechanism behind these surgical procedures, a rat partial liver transplantation (PLTx) model was established for relevant surgical studies. Because of the complexity of the rat PLTx model, a protocol with detailed descriptions is required. An article published previously reported a protocol in which ex vivo hepatectomy was used to achieve 50% rat PLTx. In contrast to this protocol, we introduced a re-arterialized PLTx with an in vivo 70% hepatectomy. An updated vessel-oriented hepatectomy was incorporated into the rat PLTx to refine the microsurgical procedure. The portal veins and hepatic arteries of the left lateral lobe and the median lobe were individually dissected and ligated before removal of the liver parenchyma, thereby decreasing the probability of bleeding in the remnant liver stump. Furthermore, an end-to-side vessel anastomosis between the common hepatic artery and the enlarged proper hepatic artery was introduced to re-arterialize the hepatic artery. By using this end-to-side vessel anastomosis technique, the diameter of the anastomosis was enlarged, thereby decreasing the difficulty of hand suture and maintaining a high rate of anastomotic patency. Moreover, the cuff anastomosis of the infrahepatic vena cava was slightly modified. A section of circumferential liver parenchyma around the vena cava of a recipient was preserved during cuff anastomosis to maintain the three-dimensional shape of the vascular lumen. This section of liver parenchyma was removed after completing the anastomosis. With this modification, the step involving placement of stay sutures was omitted, thereby further shortening the cuff anastomosis time. By using this protocol of rat PLTx, a low liver enzyme level, an intact liver lobular architecture and a high survival rate were achieved after microsurgery.

Re-Arterialized Rat Partial Liver Transplantation with an in vivo Vessel-Oriented 70% Hepatectomy

Here, a protocol involving re-arterialized rat partial liver transplantation is presented. Specifically, 70% liver was resected in vivo by using an updated technique of vessel-oriented hepatectomy. The hepatic artery was reconstructed in an end-to-side manner. The cuff technique was modified to shorten the anastomosis time of the infrahepatic vena cava.

Re-artérialisé Transplantation de foie partielle de Rat in vivo axée sur le navire 70 % hépatectomie

Split liver transplantation and living liver donor liver transplantation were developed in the clinic to utilize liver organs in a more efficient manner. ...

Invasive Hemodynamic Characterization of the Portal-hypertensive Syndrome in Cirrhotic Rats

This is a detailed protocol describing invasive hemodynamic measurements in cirrhotic rats for the characterization of portal hypertensive syndrome. Portal hypertension (PHT) due to cirrhosis is responsible for the most severe complications in patients with liver disease. The full picture of the portal hypertensive syndrome is characterized by increased portal pressure (PP) due to the increased intrahepatic vascular resistance (IHVR), hyperdynamic circulation, and increased splanchnic blood flow. Progressive splanchnic arterial vasodilation and increased cardiac output with elevated heart rate (HR) but low arterial pressure characterizes the portal hypertensive syndrome.
Novel therapies are currently being developed that aim to decrease PP by either targeting IHVR or increased splanchnic blood flow &#8212; but side effects on systemic hemodynamics may occur. Thus, a detailed characterization of portal venous, splanchnic, and systemic hemodynamic parameters, including measurement of PP, portal venous blood flow (PVBF), mesenteric arterial blood flow, mean arterial pressure (MAP), and HR is needed for preclinical evaluation of the efficacy of novel treatments for PHT. Our video article provides the reader with a structured protocol for performing invasive hemodynamic measurements in cirrhotic rats. In particular, we describe the catheterization of the femoral artery and the portal vein via an ileocolic vein and the measurement of portal venous and splanchnic blood flow via perivascular Doppler-ultrasound flow probes. Representative results of different rat models of PHT are shown.

Here we describe a detailed protocol for invasive measurements of hemodynamic parameters including portal pressure, splanchnic blood flow, and systemic hemodynamics in order to characterize the portal hypertensive syndrome in rats.

Envahissante hémodynamique caractérisation du Syndrome chez les Rats cirrhotiques portail-hypertendus

This is a detailed protocol describing invasive hemodynamic measurements in cirrhotic rats for the characterization of portal hypertensive syndrome. ...

Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen

Acute liver failure (ALF) is a clinical condition caused by various etiologies resulting in the loss of metabolic, biochemical, synthesizing, and detoxifying functions of the liver. In most irreversible liver damage cases, orthotropic liver transplant (OLT) remains the only available treatment. To study the therapeutic potential of a treatment for ALF, its prior testing in an animal model of ALF is essential. In the current study, an ALF model in rats was developed by combining 70% partial hepatectomy (PHx) and injections of acetaminophen (APAP) that provides a therapeutic window of 48 h. The median and left lateral lobes of the liver were removed to excise 70% of the liver mass and APAP was given 24 h postsurgically for 2 days. Survival in ALF-induced animals was found to be severely decreased. The development of ALF was confirmed by altered serum levels of the enzymes alanine amino transferase (ALT), aspartate amino transferase (AST), alkaline phosphatase (ALP); changes in prothrombin time (PT); and assessment of the international normalized ratio (INR). Study of the gene expression profile by qPCR revealed an increase in expression levels of genes involved in apoptosis, inflammation, and in the progression of liver injury. Diffused degeneration of hepatocytes and infiltration of immune cells was observed by histological evaluation. The reversibility of ALF was confirmed by the restoration of survival and serum levels of ALT, AST, and ALP after intrasplenic transplantation of syngeneic healthy rat hepatocytes. This model presents a reliable alternative to the available ALF animal models to study the pathophysiology of ALF as well as to evaluate the potential of a novel therapy for ALF. The use of two different approaches also makes it possible to study the combined effect of physical and drug-induced liver injury. The reproducibility and feasibility of current procedure is an added benefit of the model.

The acute liver failure animal model developed in the current study presents a feasible alternative for the study of potential therapies. The current model employs the combined effect of physical and drug-induced hepatic injury and provides a suitable time window to study the potential of novel therapies.

Génération d'un modèle de rat de l'échec aigu de foie en combinant 70% hepatectomy partiel et acétaminophène

Acute liver failure (ALF) is a clinical condition caused by various etiologies resulting in the loss of metabolic, biochemical, synthesizing, and ...

Minimizing Post-Infusion Portal Vein Bleeding during Intrahepatic Islet Transplantation in Mice

Although the liver is currently accepted as the primary transplantation site for human islets in clinical settings, islets are transplanted under the kidney capsule in most rodent preclinical islet transplantation studies. This model is commonly used because murine intrahepatic islet transplantation is technically challenging, and a high percentage of mice could die from surgical complications, especially bleeding from the injection site post-transplantation. In this study, two procedures that can minimize the incidence of post-infusion portal vein bleeding are demonstrated. The first method applies an absorbable hemostatic gelatin sponge to the injection site, and the second method involves penetrating the islet injection needle through the fat tissue first and then into the portal vein by using the fat tissue as a physical barrier to stop bleeding. Both methods could effectively prevent bleeding-induced mouse death. The whole liver section showing islet distribution and evidence of islet thrombosis post-transplantation, a typical feature for intrahepatic islet transplantation, were presented. These improved protocols refine the intrahepatic islet transplantation procedures and may help laboratories set up the procedure to study islet survival and function in pre-clinical settings.

Here we present refined surgical procedures on successfully performing intraportal islet transplantation, a clinically relevant but technically challenging surgical procedure, in mice.

Minimiser les saignements de veines portes post-perfusion pendant la transplantation intrahépatique d’îlots chez la souris

Although the liver is currently accepted as the primary transplantation site for human islets in clinical settings, islets are transplanted under the ...

Rat Model of Normothermic Ex-Situ Perfused Heterotopic Heart Transplantation

Heart transplantation is the most effective therapy for end-stage heart failure. Despite the improvements in therapeutic approaches and interventions, the number of heart failure patients waiting for transplantation is still increasing. The normothermic ex situ preservation technique has been established as a comparable method to the conventional static cold storage technique. The main advantage of this technique is that donor hearts can be preserved for up to 12 h in a physiologic condition. Moreover, this technique allows resuscitation of the donor hearts after circulatory death and applies required pharmacologic interventions to improve donor function after implantation. Numerous animal models have been established to improve normothermic ex situ preservation techniques and eliminate preservation-related complications. Although large animal models are easy to handle compared to small animal models, it is costly and challenging. We present a rat model of normothermic ex situ donor heart preservation followed by heterotopic abdominal transplantation. This model is relatively cheap and can be accomplished by a single experimenter.

Here, we present an assessment protocol of a heterotopically implanted heart after normothermic ex situ preservation in the rat model.

Modèle de rat de transplantation cardiaque hétérotopique perfusée ex situ normamère

Heart transplantation is the most effective therapy for end-stage heart failure. Despite the improvements in therapeutic approaches and interventions, the ...

Transplantation cardiaque in vivo pour étudier la transition endothéliale à mésenchymateuse

A Neonatal Heterotopic Rat Heart Transplantation Model for the Study of Endothelial-to-Mesenchymal Transition

Endocardial fibroelastosis (EFE), defined by subendocardial tissue accumulation, has major impacts on the development of the left ventricle (LV) and precludes patients with congenital critical aortic stenosis and hypoplastic left heart syndrome (HLHS) from curative anatomical biventricular surgical repair. Surgical resection is currently the only available therapeutic option, but EFE often recurs, sometimes with an even more infiltrative growth pattern into the adjacent myocardium.
To better understand the underlying mechanisms of EFE and to explore therapeutic strategies, an animal model suitable for preclinical testing was developed. The animal model takes into consideration that EFE is a disease of the immature heart and is associated with flow disturbances, as supported by clinical observations. Thus, the heterotopic heart transplantation of neonatal rat donor hearts is the basis for this model.
A neonatal rat heart is transplanted into an adolescent rat&#39;s abdomen and connected to the recipient&#39;s infrarenal aorta and inferior vena cava. While perfusion of the coronary arteries preserves the viability of the donor heart, flow stagnation within the LV induces EFE growth in the very immature heart. The underlying mechanism of EFE formation is the transition of endocardial endothelial cells to mesenchymal cells (EndMT), which is a well-described mechanism of early embryonic development of the valves and septa but also the leading cause of fibrosis in heart failure. EFE formation can be macroscopically observed within days after transplantation. Transabdominal echocardiography is used to monitor the graft viability, contractility, and the patency of the anastomoses. Following euthanasia, the EFE tissue is harvested, and it shows the same histopathological characteristics as human EFE tissue from HLHS patients.
This in vivo model allows for studying the mechanisms of EFE development in the heart and testing treatment options to prevent this pathological tissue formation and provides the opportunity for a more generalized examination of EndMT-induced fibrosis.

Pleins feux sur l’auteur : Un modèle de transplantation cardiaque de rat hétérotopique néonatal pour l’étude de la transition endothéliale à mésenchymateuse  

This work presents an animal model of endothelial-to-mesenchymal transition-induced fibrosis, as seen in congenital cardiac defects such as critical aortic stenosis or hypoplastic left heart syndrome, which allows for detailed histological tissue evaluation, the identification of regulatory signaling pathways, and the testing of treatment options.

Un modèle de transplantation cardiaque de rat hétérotopique néonatal pour l’étude de la transition endothéliale à mésenchymateuse

Endocardial fibroelastosis (EFE), defined by subendocardial tissue accumulation, has major impacts on the development of the left ventricle (LV) and ...