Bu çalışma CKB için NIH (RO1 HL098228) bir hibe, kısmen desteklendi.

Not: Bütün hayvan prosedürleri Nationwide Çocuk Hastanesi Kurumsal Hayvan Bakım ve Kullanım Kurulu tarafından kabul edildi. Kalp Vana Donör Fare 1. Pulmoner Kalp Vana Hasat <ol><li> Ameliyat öncesi tüm cerrahi aletler otoklava sokun: ince makas, 3x mikro forseps, 2x mikro vasküler kelepçeler, 1x kelepçe uygulayarak forseps, 1x mikro iğne tutucu, 1x yaylı makas, 1x ekartörünü 1x. </li><li> A 6-8 haftalık dişi C57BL / 6 fare, akciğer kalp kapak verici olarak kullanılmaktadır. Kafesinden fareyi çıkarın ve bunu tartmak, sonra bir ketamin / ksilazin kokteyl (ketamin, 200 mg / kg ve ksilizin, 20 mg / kg, IP) doz aşımı ile euthanize. </li><li> Göğüs alanı Klip ve bir yastık üzerinde bir dorsal recumbence pozisyonda fare yerleştirin. Sonra torakotomi yapmak. , Kalp maruz sağ atrium üzerinde küçük bir kesim yapmak ve buz soğuk tuzlu su ile sol ventrikül serpmek. </li><li> Açık açık artan a gelen pulmoner arter (PA) teşrihOrta. Pulmoner arter 2 mm manşet ile birlikte pulmoner kapak (PV) kesip. Kalbin kalan atınız. </li><li> Soğuk heparin ve tuzlu su çözeltisi (100 birim / ml) &#39;de PV saklayın. Not: PV verici kalp nakli önce iki saat boyunca çözelti içinde tutulabilir. </li></ol> 2.. Donör Kalp Hazırlık <ol><li> A 6-8 haftalık dişi C57BL / 6 fare kalp verici olarak kullanılır. Kafesinden fareyi çıkarın ve bunu tartmak, sonra bir ketamin / ksilazin kokteyl (ketamin, 200 mg / kg ve ksilizin, 20 mg / kg, IP) doz aşımı ile euthanize. Bu, bir terminal işlemdir. </li><li> Göğüs alanı Klip ve bir yastık üzerinde bir dorsal recumbence pozisyonda fare yerleştirin. Sonra torakotomi yapmak. Açık açık kalp, inferior vena kava (IVC), vena kava (SVK), çıkan aort, PA, ve pulmoner ven ayrı. Buz soğuk steril serum fizyolojik ile IVC serpmek. </li><li> IVC, SVC, ve daha sonra üstün kesti 6-0 ipek sütür ile pulmoner ven ligasyonubitişik harfler. </li><li> 2 mm manşeti ile aorta ve PA kesti. </li><li> PV kesip atın. </li></ol> Donör Kalp üzerine 3. Kalp Kapağı Nakli <ol><li> Hemen adım 2.5 sonra, donör kalbine 1.5 adım kalp kapakçığı yerleştirin ve kalp kapakçığı yönlendirin. </li><li> Konik iğne 10-0 monofilament dikiş kullanarak vananın sağ tarafında bir dikiş ile PV elde edin ve PV diğer taraftan 5-6 stiches sürekli dikiş başlar. </li><li> Ön tarafı bitirdikten sonra, yatay kalp döndürmek ve donör kalbin üzerine PV arka tarafını dikmek başlar. </li><li> Soğuk bir steril heparin / tuzlu su çözeltisi içinde kalp saklayın. Not: Donor kalp alıcı fareye implantasyondan önce iki saat boyunca çözelti içinde tutulabilir. </li></ol> Bir Alıcı Fare 4. Heterotopik Kalp Nakli <ol><li> Bir 6-8 haftalık dişi C57BL / 6 fare bir rezidüsünden olarak kullanılmıştırpient. Kafesinden fareyi çıkarın ve sonra ketamin / ksilazin kokteyl (ketamin, 100 mg / kg ve ksilizin 10 mg / kg) ile anestezi, tartılır. Ketoprofen (5 mg / kg) Anestezi öncesi analjesik olarak kullanılır. </li><li> Kısma kuyruk tarafından sedasyon düzeyini kontrol ettikten sonra, karın ve göğüs saç klibi. Steril Oftalmik merhem ile gözleri yağlayın ve bir yastık üzerinde bir dorsal recumbence pozisyonda fare yerleştirin. Betadine ve alkol pedleri ile karın dezenfekte edin. Daha sonra steril bir örtü ile fare kapak ve sadece kesik alana maruz kalmaktadır. </li><li> Suprapubik bölgeye xiphoid aşağıdan bir orta hat laparotomi kesi yapmak ve kendini tutma ekartörünü yerleştirin. Tuzlu çözelti ile nemlendirilmiş gazlı bez bağırsakları sarın. Açık açık infrarenal aorta ve vena kava tanımlar. </li><li> Kan dolaşımını dizginlemek aorta ve IVC etrafında proksimal ve distalde iki 6-0 ipek sütür koyun. </li><li> Abdominal aorta sağ tarafındaki donör kalbi yerleştirin ve steril GAÜ ile örtünze. Tuzlu su ile nemlendirmek. </li><li> Bir 30 G iğne kullanılarak abdominal aortta aortotomy yapın ve verici aort boyutuna makas ile açıklığı uzanır. </li><li> Konik iğne steril 10-0 monofilament sütür kullanarak bir tarafında uçtan anastomoz gerçekleştirin. Abdominal aortta açıklığın yakın ucunda bir tane dikiş ile verici aort elde edin ve abdominal aortun uzak ucundan 4-5 stiches sürekli dikiş başlar. </li><li> , Sol tarafa kalp çevirmek serum vermek gazlı bez ile örtün ve abdominal aorta uzak ucundan 4-5 stiches ile sürekli dikiş başlar. </li><li> Bir 30 G iğne kullanılarak IVC bir venotomi yapın ve verici pulmoner arter boyutuna açıklığı uzanır. </li><li> Konik iğne steril 10-0 monofilament sütür kullanarak yan anastomoz sona gerçekleştirin. IVC içinde açıklığın yakın ucunda bir tane dikiş ile verici PA elde edin ve 4-5 stiches sürekli dikiş başlarinferior vena kava uzak ucu. Aort şekilde, çünkü bu sefer, emin donörün PA sol duvarının sütür IVC iç olduğundan emin olun. </li><li> Heparin ve tuzlu su çözeltisi (100 birim / ml) ile IVC lümen yıkayın. Uzak ucuna sürekli olarak onları dikiş ile PA verici ve alıcı IVC sağ duvar kapatın. </li><li> Distal ligatürün çıkarın ve bir topikal emilebilir steril hemostat ajanı uygulayarak kanamayı kontrol. Kanama tamamen durduğunda, proksimal sütür kaldırmak ve kanama aynı şekilde kontrol. </li><li> Bağırsakları İade ve 6-0 siyah poliamid monofilament sütür kullanılarak iki kat karın kas ve deri kapatın. </li><li> 0.5 ml serum fizyolojik subkutan enjekte edilir ve fare tamamen mobil kadar bir ısınma pad üzerinde bir kurtarma kafes fare yerleştirin. Kurtarma üzerine, kağıt yatak ile yeni kafesine fareyi dönmek. 48 saat boyunca ağrı ilaç (ibuprofen, 30 mg / kg, içme suyu) ver. Dotamamen iyileşti kadar diğer hayvanların şirkete ameliyat geçirmiş bir hayvan döndürmez. </li></ol>

<ol>
	<li>Polito, A., 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=Increased+morbidity+and+mortality+in+very+preterm+VLBW+infants+with+congenital+heart+disease.">Increased morbidity and mortality in very preterm VLBW infants with congenital heart disease.</a> Intens Care Med. 39, 1104-1112 (2013).</li><li>Wren, C., Reinhardt, Z., Khawaja, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Twenty+year+trends+in+diagnosis+of+life+threatening+neonatal+cardiovascular+malformations.">Twenty year trends in diagnosis of life threatening neonatal cardiovascular malformations.</a> Arch Dis Child Fetal. 93, F33-F35 (2008).</li><li>Vacanti, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Beyond+transplantation+Third+annual+Samuel+Jason+Mixter+lecture.">Beyond transplantation Third annual Samuel Jason Mixter lecture.</a> Archives of surgery. 123, 545-549 (1960).</li><li>Tudorache, I., 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=Orthotopic+replacement+of+aortic+heart+valves+with+tissue-engineered+grafts.">Orthotopic replacement of aortic heart valves with tissue-engineered grafts.</a> Tissue engineering Part A. 19, 1686-1694 (2013).</li><li>van Geldorp, M. W., 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=Patient+outcome+after+aortic+valve+replacement+with+a+mechanical+or+biological+prosthesis+weighing+lifetime+anticoagulant+related+event+risk+against+reoperation+risk.">Patient outcome after aortic valve replacement with a mechanical or biological prosthesis weighing lifetime anticoagulant related event risk against reoperation risk.</a> The Journal of thoracic and cardiovascular surgery. 137, 881-886 (2009).</li><li>El Oakley, R., Kleine, P., Bach, D. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Choice+of+prosthetic+heart+valve+in+today's+practice.">Choice of prosthetic heart valve in today's practice.</a> Circulation. 117, 253-256 (2008).</li><li>Quinn, R. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Animal+Models+for+Bench+to+Bedside+Translation+of+Regenerative+Cardiac+Constructs.">Animal Models for Bench to Bedside Translation of Regenerative Cardiac Constructs.</a> Progress in Pediatric cardiology. 35, (2013).</li><li>Shinoka, T., 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=Tissue+engineering+heart+valves+valve+leaflet+replacement+study+in+a+lamb+model.">Tissue engineering heart valves valve leaflet replacement study in a lamb model.</a> The Annals of thoracic surgery. 60, S513-S516 (1995).</li><li>Sodian, R., 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=Tissue+engineering+of+heart+valves+in+vitro+experiences.">Tissue engineering of heart valves in vitro experiences.</a> The Annals of thoracic surgery. 70, 140-144 (2000).</li><li>Shinoka, T., 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=Tissue+engineered+heart+valves.+Autologous+valve+leaflet+replacement+study+in+a+lamb+model.">Tissue engineered heart valves. Autologous valve leaflet replacement study in a lamb model.</a> Circulation. 94, II164-II168 (1996).</li><li>Sodian, R., 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=Evaluation+of+biodegradable+three+dimensional+matrices+for+tissue+engineering+of+heart+valves.">Evaluation of biodegradable three dimensional matrices for tissue engineering of heart valves.</a> ASAIO journal (American Society for Artificial Internal Organs. 46, 107-110 (1992).</li><li>Sodian, R., 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=Early+in+vivo+experience+with+tissue-engineered+trileaflet+heart+valves).">Early in vivo experience with tissue-engineered trileaflet heart valves).</a> Circulation. 102, III22-III29 (2000).</li></ol>

Biz ifşa hiçbir şey yok.

Bu prosedürün ölüm oranı çoğunlukla alıcı abdominal aorta donör aort PV nakli site ve anastomoz de kanama neden oldu% 20, yakındır. Pek çok durumda, ölüm oranı önemli ölçüde 48 saat ameliyat sonrasında azalır. Sağkalım fareler implante PV yoluyla güçlü kalp atışlarını ve kan akışını gösterdi. Bütün bu süreç, deneyimli bir mikro cerrah için dört saat sürer. Bu tekniği ana kabaca 250 fareler alacaktır. Heterotopik kalp nakli donör kalbe PV implantasyon kıyasla öne nispeten d...

Konjenital kalp kusurları batı dünyası 1,2 bebek ölümlerinin önde gelen nedenlerinden biridir. Bunlar arasında, pulmoner kapak darlığı ve aort kapağı kusurları sık görülen şeklidir 3 vardır. Kalp kapak değiştirme ameliyatı rekonstrüktif cerrahi rutin bir seçimdir; Ancak, darlık ve kireçlenmeye kalp kapakçığı ve antikoagülan ömür boyu bağımlılık dahil komplikasyonlar, kronik hastalık ve ölüm 4-7 önemli bir kaynağıdır. Ayrıca, büyüme potansiyeli eksikliği daha genç hastalarda, 4,8,9 ve mortaliteyi artırır, revizyon ameliyatları gerektirir. Biyolojik olarak parçalanabilir bir sentetik kalp kapakçığı 8 üzerine büyüme potansiyeli, Shinoka et al. Tohumlanmış otolog hücreler olan fonksiyonel değiştirme kalp valfi geliştirmek için bir girişim olarak. Büyüme potansiyeli olan bir yapı gibi yerli kalp kapakçığı dönüştü sentetik valfal. Ön büyük hayvan çalışmaları fonksiyonel bir kalp valfini 10 oluşturmak için bu yöntemi kullanarak fizibilite göstermiştir. Bununla birlikte, uzun süreli implantasyon çalışmaları nedeniyle, kalp valfinin daralması ile sonuçlanan valf neotissue ilerleyici kalınlaşmasına kötü dayanıklılığı göstermiştir. Sodian ikinci çalışma ark. Shinoka yöntem kullanılır, ancak sonuçta daha fizyolojik bir profil oluşturmak 9,11,12 doku mühendisliği vananın biyomekanik özelliklerini veren biyolojik olarak parçalanabilir bir elastomer ile PGA matris yerini aldı. In vivo çalışmada, implantasyon başarısı rağmen, birleşik endotel hücre astar bu iskele 12&#39;nin uzun sürede başarısını sınırı düşüren oluşmuş değildi. Rasyonel geliştirilmiş ikinci nesil sentetik kalp kapağı tasarlamak amacıyla, kalp kapakçığı nakli bir fare modeli hücresel ve moleküler mekanizmaları underlyin araştırmak için kuruldug neotissue oluşumu, valf kalınlaşma ve darlık gelişimi. Fare modelleri diğer türlerde 7 hazır değildir transgenikleri dahil olmak üzere moleküler belirteçlerin geniş bir dizi, sunuyoruz. Bu kalp kapakçığı nakli modelinde, ex vivo singenik pulmoner kalp kapak replasmanı ilk gerçekleştirilmiştir; ve daha sonra implante edilen kalp kapağı ile kalp bir mikrocerrahi tekniği kullanılarak bir konakçıya genetik olarak özdeş heterotopically implante edildi. Bu model, kardiyopulmoner baypas için gerek kalmadan kalp kapağı değişimi sağlar. Bu yazıda, bir kalp kapakçığı hasat ayrıntılı bir açıklama, donör kalp preparatları, kalp kapakçığı nakli ve heterotopik kalp nakli tarif edilir. Sonuçlar alıcı atışı bağımsız olduğu donör kalp, sürekli bir kalp atışı gösterdi. Implante pulmoner valf kan akışı, atımlı bir dalga fazlası ile yüksek frekanslı ultrason sistemi kullanılarak ölçüldüppler.

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		<col />
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		<col />
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		<tr height="20">
			<td height="20" style="height:20px;width:176px;">DPBS</td>
			<td style="width:167px;">gibco</td>
			<td style="width:133px;">14190-144</td>
			<td style="width:168px;"></td>
		</tr>
		<tr height="24">
			<td height="24" style="height:24px;width:176px;">Microscope</td>
			<td style="width:167px;">Leica</td>
			<td style="width:133px;">M80</td>
			<td style="width:168px;"></td>
		</tr>
		<tr height="25">
			<td height="25" style="height:25px;width:176px;">C57BL/6J (H-2b), Female</td>
			<td style="width:167px;">Jackson Laboratories&#160;</td>
			<td style="width:133px;">664</td>
			<td style="width:168px;">8-12 weeks</td>
		</tr>
		<tr height="39">
			<td height="39" style="height:39px;width:176px;">Ketamine Hydrochloride Injection</td>
			<td style="width:167px;">Hospira Inc.</td>
			<td style="width:133px;">NDC 0409-2053</td>
			<td style="width:168px;"></td>
		</tr>
		<tr height="23">
			<td height="23" style="height:23px;width:176px;">Xylazine Sterile Solution</td>
			<td style="width:167px;">Akorn Inc.</td>
			<td style="width:133px;">NADA# 139-236</td>
			<td style="width:168px;"></td>
		</tr>
		<tr height="36">
			<td height="36" style="height:36px;width:176px;">ketoprofen</td>
			<td style="width:167px;">Fort Dodge Animal Health</td>
			<td style="width:133px;">NDC 0856-4396-01</td>
			<td style="width:168px;"></td>
		</tr>
		<tr height="36">
			<td height="36" style="height:36px;width:176px;">Ibuprofen</td>
			<td style="width:167px;">PrecisionDose</td>
			<td style="width:133px;">NDC 68094-494-59</td>
			<td style="width:168px;"></td>
		</tr>
		<tr height="37">
			<td height="37" style="height:37px;width:176px;">Heparin Sodium</td>
			<td style="width:167px;">Sagent Pharmaceticals</td>
			<td style="width:133px;">NDC 25021-400</td>
			<td style="width:168px;"></td>
		</tr>
		<tr height="39">
			<td height="39" style="height:39px;width:176px;">Saline solution (Sterile 0.9% Sodium Chloride)</td>
			<td style="width:167px;">Hospira Inc.</td>
			<td style="width:133px;">NDC 0409-0138-22</td>
			<td style="width:168px;"></td>
		</tr>
		<tr height="39">
			<td height="39" style="height:39px;width:176px;">0.9% Sodium Chloride Injection</td>
			<td style="width:167px;">Hospira Inc.</td>
			<td style="width:133px;">NDC 0409-4888-10</td>
			<td style="width:168px;"></td>
		</tr>
		<tr height="41">
			<td height="41" style="height:41px;width:176px;">Petrolatum Ophthalmic Ointment</td>
			<td style="width:167px;">Dechra Veterinary Products</td>
			<td style="width:133px;">NDC 17033-211-38</td>
			<td style="width:168px;"></td>
		</tr>
		<tr height="23">
			<td height="23" style="height:23px;width:176px;">Iodine Prep Pads</td>
			<td style="width:167px;">Triad Disposables, Inc.</td>
			<td style="width:133px;">NDC 50730-3201-1</td>
			<td style="width:168px;"></td>
		</tr>
		<tr height="23">
			<td height="23" style="height:23px;width:176px;">Alcohol Prep Pads</td>
			<td style="width:167px;">McKesson Corp.</td>
			<td style="width:133px;">NDC 68599-5805-1</td>
			<td style="width:168px;"></td>
		</tr>
		<tr height="23">
			<td height="23" style="height:23px;width:176px;">Cotton tipped applicators</td>
			<td style="width:167px;">Fisher Sientific</td>
			<td style="width:133px;">23-400-118</td>
			<td style="width:168px;"></td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:176px;">Fine Scissor</td>
			<td style="width:167px;">FST</td>
			<td style="width:133px;">14028-10</td>
			<td style="width:168px;"></td>
		</tr>
		<tr height="23">
			<td height="23" style="height:23px;width:176px;">Micro-Adson Forcep</td>
			<td style="width:167px;">FST</td>
			<td style="width:133px;">11018-12</td>
			<td style="width:168px;"></td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:176px;">Clamp Applying Forcep</td>
			<td style="width:167px;">FST</td>
			<td style="width:133px;">00072-14</td>
			<td style="width:168px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:176px;">S&#38;T Vascular Clamp</td>
			<td style="width:167px;">FST</td>
			<td style="width:133px;">00396-01</td>
			<td style="width:168px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:176px;">Spring Scissors</td>
			<td style="width:167px;">FST</td>
			<td style="width:133px;">15008-08</td>
			<td style="width:168px;"></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:176px;">Colibri Retractors</td>
			<td style="width:167px;">FST</td>
			<td style="width:133px;">17000-04</td>
			<td style="width:168px;"></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:176px;">Dumont #5 Forcep</td>
			<td style="width:167px;">FST</td>
			<td style="width:133px;">11251-20&#160;</td>
			<td style="width:168px;"></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:176px;">Dumont #7 - Fine Forceps</td>
			<td style="width:167px;">FST</td>
			<td style="width:133px;">11274-20</td>
			<td style="width:168px;"></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:176px;">Dumont #5/45 Forceps</td>
			<td style="width:167px;">FST</td>
			<td style="width:133px;">11251-35</td>
			<td style="width:168px;"></td>
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		<tr height="20">
			<td height="20" style="height:20px;width:176px;">Tish Needle Holder/Forceps</td>
			<td style="width:167px;">Micrins</td>
			<td style="width:133px;">MI1540</td>
			<td style="width:168px;"></td>
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		<tr height="38">
			<td height="38" style="height:38px;width:176px;">Black Polyamide Monofilament Suture, 10-0</td>
			<td style="width:167px;">AROSurgical Instruments Corporation</td>
			<td style="width:133px;">TI638402</td>
			<td style="width:168px;">For sutureing the graft</td>
		</tr>
		<tr height="37">
			<td height="37" style="height:37px;width:176px;">Black Polyamide Monofilament Suture, 6-0</td>
			<td style="width:167px;">AROSurgical Instruments&#160;</td>
			<td style="width:133px;">SN-1956</td>
			<td style="width:168px;">For musculature and skin closure</td>
		</tr>
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transplantation of pulmonary valve using a mouse model of heterotopic heart transplantation

Doku mühendisliği kalp kapakçıkları, özellikle decellularized vanalar, karışık sonuçlar rekonstrüktif cerrahi klinik kullanımda ivme kazanmaya başlıyor. Bununla birlikte, neotissue geliştirme, valf kalınlaşma ve stenoz gelişme hücresel ve moleküler mekanizmalar kapsamlı araştırılmış değildir. Yukarıdaki soruları cevaplamak için, biz bir kemirgen heterotopik kalp kapakçığı nakli modeli geliştirdi. Kalp valfi bir valf verici fareden toplanmış ve bir kalp verici fareye transplante edildi. Yeni bir vana ile kalp bir alıcı fareye heterotopically nakil oldu. Nakledilen kalp alıcının kalp atışı bağımsız, kendi kalp atışlarını gösterdi. Kan akışı, atımlı bir dalga Doppler ile yüksek frekanslı bir ultrason sistemi kullanılarak ölçülmüştür. Implante pulmoner valf üzerinden akış minimal yetersizliği akışını ileri gösterdi ve pik akım 100 mm / sn yakın oldu. Kalp kapağı nakli Bu fare modeli olan Highlçok yönlü y, değiştirilmiş ve bu nedenle farklı hemodinamik ortamlar sağlamak için ve / veya bir doku mühendisliği kalp valf neotissue gelişimini incelemek için çeşitli transgenik fareler ile birlikte kullanılabilir uyarlanabilir.

Şekil 1 heterotopik kalp nakli kullanarak kalp kapakçığı nakli modelinin şemaları göstermektedir. Kalp kapakçığı, bir donör kalbi hasat ve bir ikinci verici fareden alınan bir kalp üzerine yerleştirildi. Ardından yeni kalp kapak ile kalp bir alıcı fare karın implante edildi. 2. sağ kalp transplantasyonu (B) sonrasında, karın boşluğu (A) implante kalp bir örnek gösterir ve nakilden sonra 5 dk Şekil. Aort ve IV...

Watch this Scientific Journal Video about Transplantation of Pulmonary Valve Using a Mouse Model of Heterotopic Heart Transplantation at JoVE.com

Transplantation of Pulmonary Valve Using a Mouse Model of Heterotopic Heart Transplantation

Doku mühendisliği kalp kapakçıklarında neotissue oluşumu ve darlık gelişimi altında yatan hücresel ve moleküler mekanizmaları anlamak için, heterotopik kalp kapakçığı nakli bir fare modeli geliştirilmiştir. Bir pulmoner kalp kapak heterotopik kalp nakli tekniği kullanılarak alıcıya nakil oldu.

Heterotopik Kalp Nakli bir Fare Modeli Kullanarak Pulmoner Vana Nakli

Tissue engineered heart valves, especially decellularized valves, are starting to gain momentum in clinical use of reconstructive surgery with mixed ...

transplantation-pulmonary-valve-using-mouse-model-heterotopic-heart

Research

JoVE Journal

Medicine

18.8K Görüntüleme.  Nationwide Children's Hospital.  Doku mühendisliği kalp kapakçıklarında neotissue oluşumu ve darlık gelişimi altında yatan hücresel ve moleküler mekanizmaları anlamak için, heterotopik kalp kapakçığı nakli bir fare modeli geliştirilmiştir. Bir pulmoner kalp kapak heterotopik kalp nakli tekniği kullanılarak alıcıya nakil oldu. 

Video: Transplantation of Pulmonary Valve Using a Mouse Model of Heterotopic Heart Transplantation

A Mouse Model of in Utero Transplantation

The transplantation of stem cells and viruses in utero has tremendous potential for treating congenital disorders in the human fetus. For example, in utero transplantation (IUT) of hematopoietic stem cells has been used to successfully treat patients with severe combined immunodeficiency.1,2 In several other conditions, however, IUT has been attempted without success.3 Given these mixed results, the availability of an efficient non-human model to study the biological sequelae of stem cell transplantation and gene therapy is critical to advance this field. We and others have used the mouse model of IUT to study factors affecting successful engraftment of in utero transplanted hematopoietic stem cells in both wild-type mice4-7 and those with genetic diseases.8,9 The fetal environment also offers considerable advantages for the success of in utero gene therapy. For example, the delivery of adenoviral10, adeno-associated viral10, retroviral11, and lentiviral vectors12,13 into the fetus has resulted in the transduction of multiple organs distant from the site of injection with long-term gene expression. in utero gene therapy may therefore be considered as a possible treatment strategy for single gene disorders such as muscular dystrophy or cystic fibrosis. Another potential advantage of IUT is the ability to induce immune tolerance to a specific antigen. As seen in mice with hemophilia, the introduction of Factor IX early in development results in tolerance to this protein.14 
In addition to its use in investigating potential human therapies, the mouse model of IUT can be a powerful tool to study basic questions in developmental and stem cell biology. For example, one can deliver various small molecules to induce or inhibit specific gene expression at defined gestational stages and manipulate developmental pathways. The impact of these alterations can be assessed at various timepoints after the initial transplantation. Furthermore, one can transplant pluripotent or lineage specific progenitor cells into the fetal environment to study stem cell differentiation in a non-irradiated and unperturbed host environment.
The mouse model of IUT has already provided numerous insights within the fields of immunology, and developmental and stem cell biology. In this video-based protocol, we describe a step-by-step approach to performing IUT in mouse fetuses and outline the critical steps and potential pitfalls of this technique.

A Mouse Model of in Utero Transplantation

The mouse model of in utero transplantation is a versatile tool that can be used to study the potential clinical applications of stem cell transplantation and gene therapy in the fetus. In this protocol, we present a general approach to performing this technique

Bir Fare Modeli Utero Organ Nakli

The transplantation of stem cells and viruses in utero has tremendous potential for treating congenital disorders in the human fetus.  For example, in ...

Tıp

Murine Cervical Heart Transplantation Model Using a Modified Cuff Technique

Mouse models are of special interest in research since a wide variety of monoclonal antibodies and commercially defined inbred and knockout strains are available to perform mechanistic in vivo studies. While heart transplantation models using a suture technique were first successfully developed in rats, the translation into an equally widespread used murine equivalent was never achieved due the technical complexity of the microsurgical procedure. In contrast, non-suture cuff techniques, also developed initially in rats, were successfully adapted for use in mice1-3. This technique for revascularization involves two major steps I) everting the recipient vessel over a polyethylene cuff; II) pulling the donor vessel over the formerly everted recipient vessel and holding it in place with a circumferential tie. This ensures a continuity of the endothelial layer, short operating time and very high patency rates4.
Using this technique for vascular anastomosis we performed more than 1,000 cervical heart transplants with an overall success rate of 95%. For arterial inflow the common carotid artery and the proximal aortic arch were anastomosed resulting in a retrograde perfusion of the transplanted heart. For venous drainage the pulmonary artery of the graft was anastomosed with the external jugular vein of the recipient5.
Herein, we provide additional details of this technique to supplement the video.

The murine cervical heart transplantation model is well suited for immunological as well as ischemia reperfusion injury studies. We modified the procedure using a non-suture cuff technique and performed more than 1,000 successful transplants with this approach.
Herein, we provide additional details of this technique to supplement the video.

Modifiye Manşet Tekniği Sıçangiller Servikal Kalp Nakli Modeli

Mouse models are of special interest in research since a wide variety of monoclonal antibodies and commercially defined inbred and knockout strains are ...

Murine Heterotopic Heart Transplant Technique

It is now over forty years since this technique was first reported by Corry, Wynn and Russell. Although it took some years for other labs to become proficient in and utilize this technique, it is now widely used by many laboratories around the world. A significant refinement to the original technique was developed and reported in 2001 by Niimi. Described here are the techniques that have evolved over more than a decade in the hands of three surgeons (Plenter, Grazia, Pietra) in our center. These techniques are now being passed on to a younger generation of surgeons and researchers.
Based largely on the Niimi experience, the procedures used have evolved in the fine details - details which we will endeavor to relate here in such a way that others may be able to use this very useful model. Like Niimi, we have found that a video aid to learning is a priceless resource for the beginner.

The manuscript describes the steps required to perform the heterotopic heart transplant in the mouse.

Mürin Heterotopik Kalp Nakli Tekniği

It is now over forty years since this technique was first reported by Corry, Wynn and Russell. Although it took some years for other labs to become ...

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.

Sıçan Heterotopik Abdominal Kalp / Bir Ses yüklenen Yapılandırması Tek akciğer transplantasyonu

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.

Farelerde Heterotopik Servikal Kalp Nakli

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

A Novel Microsurgical Model for Heterotopic, En Bloc Chest Wall, Thymus, and Heart Transplantation in Mice

Exploration of novel strategies in organ transplantation to prolong allograft survival and minimizing the need for long-term maintenance immunosuppression must be pursued. Employing vascularized bone marrow transplantation and co-transplantation of the thymus have shown promise in this regard in various animal models.1-11 Vascularized bone marrow transplantation allows for the uninterrupted transfer of donor bone marrow cells within the preserved donor microenvironment, and the incorporation of thymus tissue with vascularized bone marrow transplantation has shown to increase T-cell chimerism ultimately playing a supportive role in the induction of immune regulation. The combination of solid organ and vascularized composite allotransplantation can uniquely combine these strategies in the form of a novel transplant model. Murine models serve as an excellent paradigm to explore the mechanisms of acute and chronic rejection, chimerism, and tolerance induction, thus providing the foundation to propagate superior allograft survival strategies for larger animal models and future clinical application. Herein, we developed a novel heterotopic en bloc chest wall, thymus, and heart transplant model in mice using a cervical non-suture cuff technique. The experience in syngeneic and allogeneic transplant settings is described for future broader immunological investigations via an instructional manuscript and video supplement.

To study combined solid organ and vascularized composite allotransplantation, we describe a novel heterotopic en bloc chest wall, thymus, and heart transplant model in mice using a cervical non-suture cuff technique.

Farelerde A Novel Mikrocerrahi Heterotopik Modeli, En Bloku Göğüs Duvarı, Thymus ve Kalp Nakli

Exploration of novel strategies in organ transplantation to prolong allograft survival and minimizing the need for long-term maintenance immunosuppression ...

A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation

Fifty-years following the first successful report, cardiac transplantation remains the gold-standard treatment for eligible patients with advanced heart failure. Multiple small-animal models of heart transplantation have been used to study the acute and long-term effects of novel therapies. However, few are tested and demonstrated success in clinical trials. It is of critical importance to evaluate new therapies in a clinically relevant large-animal model for efficient and reliable translation of basic studies&#39;&#160;findings. Here, we describe a pre-clinical large-animal (porcine) model of orthotopic heart transplantation that has been firmly established and previously used to investigate novel cardioprotective strategies. This procedure focuses on acute ischemia-reperfusion injury and is a reliable method to investigate novel interventions which have been tested and validated in smaller experimental models, such as the murine model. We demonstrate its usefulness in assessing cardiac performance during the early post-transplantation period and other potential possibilities enabled by the model.

Here, we describe a pre-clinical large-animal (porcine) model of orthotopic heart transplantation that has been firmly established and utilized to investigate novel cardioprotective strategies.

Ortootopik kalp transplantasyonunun klinik öncesi porcine modeli

Fifty-years following the first successful report, cardiac transplantation remains the gold-standard treatment for eligible patients with advanced heart ...

A Simplified Model for Heterotopic Heart Valve Transplantation in Rodents

There is an urgent clinical need for heart valve replacements that can grow in children. Heart valve transplantation is proposed as a new type of transplant with the potential to deliver durable heart valves capable of somatic growth with no requirement for anticoagulation. However, the immunobiology of heart valve transplants remains unexplored, highlighting the need for animal models to study this new type of transplant. Previous rat models for heterotopic aortic valve transplantation into the abdominal aorta have been described, though they are technically challenging and costly. For addressing this challenge, a renal subcapsular transplant model was developed in rodents as a practical and more straightforward method for studying heart valve transplant immunobiology. In this model, a single aortic valve leaflet is harvested and inserted into the renal subcapsular space. The kidney is easily accessible, and the transplanted tissue is securely contained in a subcapsular space that is well vascularized and can accommodate a variety of tissue sizes. Furthermore, because a single rat can provide three donor aortic leaflets and a single kidney can provide multiple sites for transplanted tissue, fewer rats are required for a given study. Here, the transplantation technique is described, providing a significant step forward in studying the transplant immunology of heart valve transplantation.

This protocol describes a simple and efficient method for the transplantation of aortic valve leaflets under the renal capsule to allow for the study of alloreactivity of heart valves.

Kemirgenlerde Heterotopik Kalp Kapağı Transplantasyonu için Basitleştirilmiş Bir Model

There is an urgent clinical need for heart valve replacements that can grow in children. Heart valve transplantation is proposed as a new type of ...

A Porcine Heterotopic Heart Transplantation Protocol for Delivery of Therapeutics to a Cardiac Allograft

Cardiac transplantation is the gold standard treatment for end-stage heart failure. However, it remains limited by the number of available donor hearts and complications such as primary graft dysfunction and graft rejection. The recent clinical use of an ex vivo perfusion device in cardiac transplantation introduces a unique opportunity for treating cardiac allografts with therapeutic interventions to improve function and avoid deleterious recipient responses. Establishing a translational, large-animal model for therapeutic delivery to the entire allograft is essential for testing novel therapeutic approaches in cardiac transplantation. The porcine, heterotopic heart transplantation model in the intraabdominal position serves as an excellent model for assessing the effects of novel interventions and the immunopathology of graft rejection. This model additionally offers long-term survival for the pig, given that the graft is not required to maintain the recipient's circulation. The aim of this protocol is to provide a reproducible and robust approach for achieving ex vivo delivery of a therapeutic to the entire cardiac allograft prior to transplantation and provide technical details to perform a survival heterotopic transplant of the ex vivo perfused heart.

We present a protocol for utilizing a normothermic ex vivo sanguinous perfusion system for the delivery of therapeutics to an entire cardiac allograft in a porcine heterotopic heart transplant model.

Terapötiklerin Kardiyak Allogrefte Verilmesi için Domuz Heterotopik Kalp Transplantasyonu Protokolü

Cardiac transplantation is the gold standard treatment for end-stage heart failure. However, it remains limited by the number of available donor hearts ...

A Modified Cuff Technique for Mouse Cervical Heterotopic Heart Transplantation Model

Cardiac allograft rejection limits the long-term survival of patients after heart transplantation. A mouse heart transplantation model is ideal for investigating the mechanism of cardiac allograft rejection in preclinical studies because of their high homology with human genes. This understanding would help develop unique approaches to improving patients&#39; long-term survival treated with cardiac allografts. In a mouse model, abdominal donor heart implantation is commonly performed with an end-to-end&#160;anastomosis to the recipient&#39;s aorta and inferior vena cava using stitches. In this model, the donor&#39;s heart is implanted by end-to-end anastomosis to the recipient&#39;s carotid artery and jugular vein by the modified-Cuff technique. The transplantation surgery is performed without stitching and thus may increase the survival of the recipient since there is no interference with the blood supply and venous reflux of the lower body. This mouse model would help investigate the mechanisms underlying the immunological and pathological (acute/chronic) rejection of cardiac allografts.

In the present protocol, a mouse heart transplantation model is used for investigating the mechanism of cardiac allograft rejection. In this heterotopic heart transplantation model, operation efficiency is improved, and the survival of cardiac grafts is ensured by a cervical end-to-end anastomosis of heart implantation using a modified Cuff technique.

Fare Servikal Heterotopik Kalp Transplantasyon Modeli için Modifiye Manşet Tekniği

Cardiac allograft rejection limits the long-term survival of patients after heart transplantation. A mouse heart transplantation model is ideal for ...