An Open Patch‐Graft Technique for Correction of Pulmonic Stenosis in the Dog

Abstract

An open patch-graft technique for correction of pulmonic stenosis was performed in four dogs. A synthetic patch-graft was presutured to a partial-thickness incision in the right ventricular outflow tract and to the pulmonary artery along its cranial border. The pulmonary artery and right ventricle were incised during venous inflow occlusion, and dysplastic pulmonic valve leaflets were excised. The arteriotomy was closed by suturing the caudal margin of the incision to the patch-graft. The entire procedure was performed during mild hypothermia (30 degrees - 32 degrees C). The mean circulatory arrest time was 5.5 +/- 0.2 minutes. The mean systolic pressure gradient across the pulmonic valve before surgery was 121 +/- 29 mm Hg; after surgery it was 9 +/- 2 mm Hg.

Avaliação clínica de cães submetidos à parada circulatória total por diferentes períodos de tempo através da técnica de "Inflow Occlusion"

“…A relação entre o nível da temperatura do paciente no período transoperatório e o tempo da parada circulatória estão intimamente relacionadas quando da aplicação da técnica do "Inflow Occlusion" (Bigelow et al 1990, Orton et al 1990). Apesar de um dos objetivos deste trabalho ter sido a observação de animais submetidos à técnica de parada circulatória total em normotermia, pôde-se constatar que em alguns casos as mesmas atingiram quase dois graus abaixo do estabelecido para o indivíduo (37 o C).…”

“…Em relação ao tempo de parada circulatória, os dados mostraram-se superiores aos preconizados por Orton et al (1990), mas inferiores aos mostrados por Hunt et al (1992). Há resultados que contradizem aqueles encontrados pelo último autor, o qual afirma que dos três animais estudados utilizando-se de oito minutos de parada circulatória total em normotermia, houve 100% de sobrevida dos mesmos, sem quaisquer lesões neurológicas no período pós-operatório.…”

Cardiovascular Effects of Right Ventricle-Pulmonary Artery Valved Conduit Implantation in Experimental Pulmonic Stenosis

“…Strategies for treating severe pulmonic stenosis include pulmonary valvulotomy or valvulectomy [13], transventricular pulmonic dilation valvuloplasty [9], closed patch-graft valvuloplasty [4,33], open patch-graft valvuloplasty [19] and balloon dilation valvuloplasty [5,7,20,21,30]. Although patch-graft valvuloplasty is an effective radical treatment for PS, circulation arrest time is limited using inflow occlusion [27] and cardiopulmonary bypass (CPB) is necessary for cardioplegic arrest [26]. On the other hand, although balloon dilation valvuloplasty is a popular strategy, the results in dogs with PS accompanied by dysplasia of the pulmonic annulus and main pulmonary artery are inferior to those obtained in dogs with PS alone [7].…”

A Long Term Comparison between Denacol EX-313-Treated Bovine Jugular Vein Graft and Ultrafine Polyester Fiber Graft for Reconstruction of Right Ventricular Outflow Tract in Dogs.

“…Patch grafts of pericardium, dacron, etc., have been used for reconstruction of the right ventricular outflow tract stenosis that is observed in pulmonic stenosis and tetralogy of Fallot [3,5,10], but because there have been problems, such as maneuverability and postoperative tissue reactions, it has been hoped that a new graft material would be developed. Polyepoxy compounds (Denacol ® EX-313) is less toxic than the cross-linker glutaraldehyde that has been used in the past, and because it is hydrophilic, it is characterized by strong affinity for cells and has been used for treating natural graft material, such as bovine vein [4,7,14].…”