Fresh Autologous Pericardium to Reconstruct the Pulmonary Valve at the Annulus When Tetralogy of Fallot Requires a Transannular Patch at Midterm

Pande, Shantanu; Sharma, Jugal Kishor; Siddartha, CR; Bansal, Anubhav; Agarwal, Surendra Kumar; Tewari, Prabhat; Kapoor, Aditya

doi:10.14503/thij-14-4609

Cited by 8 publications

(6 citation statements)

References 28 publications

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“…This observation has been validated in our previous study. [19] The severity of PR is also affected by the right ventricular function. Right ventricle starts showing dilation and gradual loss of its function as early as 4 years in follow-up.…”

Section: Discussionmentioning

confidence: 99%

Assessment of untreated fresh autologous pericardium as material for construction of heart valve: Result at 5 years

et al. 2019

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Introduction: Tetralogy of Fallot requiring transannular repair of the right ventricular outflow tract (RVOT) are exposed to free pulmonary insufficiency and hence inevitable right ventricular dysfunction. This study analyzes the function and structure of untreated autologous pericardium monocusp used to create a competent pulmonary valve. Materials and Methods: This is a retrospective analysis of 52 cases operated between December 2006 and December 2012. Untreated autologous pericardium was used for creating a competent pulmonary valve following a transannular patch. They are followed for functional and structural assessment of the pulmonary valve by echocardiography. Positron emission tomography (PET) with 18 fluorodeoxyglucose was performed in two cases for profiling the pulmonary valve. Results: Median age was 10.5 years (1–38). The follow-up was complete for 42 (80.76%) patients for 3 years and 25 (48.07%) patients for 5 years. The RVOT gradient was 42 mmHg (16–96) in the year of surgery, which reduced to 26 mmHg (10–58) and pulmonary insufficiency that was present in 8.3% of patients in 1 st year was witnessed in 22.7% in the 5 th year of follow-up. The monocusp patch was successful in creating a competent valve while maintaining its structure at 3 years; however, it became distorted and retracted at 5 years of follow-up. There was no calcification in any of the patients. PET-computed tomography confirmed the uptake of glucose by monocusp at 1 year of follow-up. Conclusion: The untreated autologous pericardium functioned well when it was used to create a competent pulmonary valve at short term and midterm. Although it changed in its structure; there was no calcification at 5 years of follow-up.

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Section: Discussionmentioning

confidence: 99%

Assessment of untreated fresh autologous pericardium as material for construction of heart valve: Result at 5 years

et al. 2019

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“…С осознанием данной проблемы была начата разработка хирургических подходов для сохранения нормальной функции клапана ЛА. Для этого были предложены материалы c запирательными элементами, включая аутологичный перикард, легочные клапаны животных, синтетические заплаты, механические клапаны, яремные вены крупного рогатого скота и гомографты [12][13][14][15][16]. Несмотря на усилия, идеальное решение не найдено.…”

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Bovine monocusp in surgery for tetralogy of Fallot

Свободов¹,

Левченко²,

Неталиева³

et al. 2020

PKiK

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Aim. To evaluate the functionality of a bovine monocusp in surgery for tetralogy of Fallot.Methods. We analyzed the results of surgical treatment in the early postoperative period in eight infants and one year after surgery in seven infants (age range, 0–12 months; mean weight = 7.5 ± 2.3 kg). We used echocardiography to evaluate the residual pressure gradient between the right ventricle and the pulmonary artery, the degree of regurgitation on the pulmonary valve after surgery and to calculate Z-score and the fibrous ring diameter of the pulmonary valve in the late follow-up period. The degree of insufficiency was assessed by the width and depth of the regurgitation flow using the color Doppler mode.Results. The pressure gradient on the eve of discharge did not exceed 25 mmHg for any patient. Pulmonary valve regurgitation was mild in four patients and moderate in the remaining patients. Seven children passed the observation one year after surgery. In one case, we discovered a right ventricle outflow tract obstruction. In other cases, the systolic pressure gradient did not exceed 25 mmHg. Four patients in the late follow-up period had severe valve regurgitation. Despite such valve insufficiency, the leaflet mobility in the bovine jugular vein patch was normal.Conclusion. Early postoperative results for reconstructive surgery to repair tetralogy of Fallot with a bovine monocusp were promising. However, long-term results are comparable with those using other materials. The mobility of the native leaflet remains full even a year after surgery. Consequently, we have positive prospects in material improvement for making patches with native monocusps.Received 14 May 2020. Revised 8 June 2020. Accepted 10 June 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributions Conception and study design: A.A. Svobodov, E.G. Levchenko, V.T. Kostava Data collection and analysis: G.S. Netalieva, M.V. Zelivyanskaya Statistical analysis: E.G. Levchenko, M.V. Zelivyanskaya Drafting the article: A.A. Svobodov, V.S. Rasumovsky Critical revision of the article: V.S. Rasumovsky Final approval of the version to be published: A.A. Svobodov, E.G. Levchenko, G.S. Netalieva, V.T. Kostava, M.V. Zelivyanskaya, V.S. Rasumovsky

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“…Proponents of autologous fresh pericardium believe that not only does it reduce the development of future pericardial calcification but also it increases the chance of live pericardial cells to survive, which ensures commensuration with the growth of the patient and greatly lessens the likelihood of patch-site stenosis. 5 In contrast, some experts prefer the treated autologous pericardium, which is prepared by exposure to glutaraldehyde, and posit that glutaraldehyde-treated patches are easier to handle in limited anatomic exposures and the strength of the cross-links between glutaraldehyde and collagen boost the strength of the pericardial patch. 3 - 6 …”

Section: Introductionmentioning

confidence: 99%

The fate of the fresh autologous pericardium after right ventricular outflow tract reconstruction

Tatari

Omrani

Arabian

et al. 2022

J Cardiovasc Thorac Res

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Introduction: The autologous pericardium, treated or fresh, is used in reconstructive cardiovascular surgery. We aimed to describe the features of fresh pericardium utilized in right ventricular outflow tract (RVOT) reconstruction, years after the initial surgery. Methods: This cross-sectional study was performed on 72 patients (65.3% male, mean age =18.68 ± 9.63 y) with a history of RVOT reconstruction with the fresh autologous pericardium who underwent reoperation. During the surgery, a 1 × 1 cm sample was cut from the previous pericardial patch, and hematoxylin and eosin (H & E), Masson’s trichrome, and immunohistochemistry (IHC) staining was conducted. All the stained slides were evaluated,and the descriptive results were explained. Results: The mean follow-up duration was 13.48 ± 7.38 years. In preoperative evaluations,53 (73.6%) patients exhibited no RVOT dilatation, 17 (23.6%) showed mild RVOT dilatation,and 2 (2.8%) had RVOT aneurysms. The H & E staining revealed no calcification in 80.55%(58/72), mild calcification in 9.72% (7/72), and moderate calcification in 9.72% (7/72) of the total samples. None of the specimens demonstrated a marked calcification. All the samples were positive for CD31, CD34, smooth muscle alpha-actin, and von Willebrand factor in IHC. In Masson’s trichrome staining, on average, 64.74% (±18.61) of the tissue sections contained collagen fibers. Conclusion: The fresh autologous pericardium, utilized for RVOT reconstruction, showed viability, growth potential, positivity for endothelial cell markers, vascular differentiation,insignificant calcification, and no stenosis at long-term follow-up. We would, therefore, suggest it as a suitable choice for such reconstructive operations. Moreover, its usage during total correction of tetralogy of Fallot could be safe, feasible, and durable.

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Fresh Autologous Pericardium to Reconstruct the Pulmonary Valve at the Annulus When Tetralogy of Fallot Requires a Transannular Patch at Midterm

Cited by 8 publications

References 28 publications

Assessment of untreated fresh autologous pericardium as material for construction of heart valve: Result at 5 years

Assessment of untreated fresh autologous pericardium as material for construction of heart valve: Result at 5 years

Bovine monocusp in surgery for tetralogy of Fallot

The fate of the fresh autologous pericardium after right ventricular outflow tract reconstruction

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