This study aimed to produce an acellular human tissue scaffold with a view to recellularization with autologous cells to produce a tissue-engineered pericardium that can be used as a patch for cardiovascular repair. Human pericardia from cadaveric donors were treated sequentially with hypotonic buffer, SDS in hypotonic buffer, and a nuclease solution. Histological analysis of decellularized matrices showed that the human pericardial tissue retained its histioarchitecture and major structural proteins. There were no whole cells or cell fragments. There were no significant differences in the hydroxyproline (normal and denatured collagen) and glycosaminoglycan content of the tissue before and after decellularization (p > 0.05). There were no significant changes in the ultimate tensile strength after decellularization (p > 0.05). However, there was an increased extensibility when the tissue strips were cut parallel to the visualized collagen bundles (p = 0.005). No indication of contact or extract cytotoxicity was found when using human dermal fibroblasts and A549 cells. In summary, successful decellularization of the human pericardium was achieved producing a biocompatible matrix that retained the major structural components and strength of the native tissue.
Background-The technical aspects of ductal stenting have been reported, but little is known of the fate of the duct after stent implantation. Methods and Results-Nineteen patients underwent stent implantation to maintain ductal patency. Eight had hypoplastic left heart (HLH) syndrome, 10 had pulmonary atresia, and 1 had tricuspid atresia. Median survival with HLH was 57 (12 to 907) days. Stent implantation was successful in all cases of HLH, but there were no long-term survivors. Two well-palliated infants died at transplantation. Median survival with duct-dependant pulmonary flow was 183 (0 to 1687) days, with 3 patients well at latest follow-up (56, 55, and 9 months, respectively). There were 2 operative deaths due to ductal spasm and 4 late deaths, 1 due to duct thrombosis, 1 due to chronic lung disease, and 2 of unknown cause. Stent implantation failed in 4 of the 11 cases. Assessment of endothelialization was possible in 13 cases; the stent was partially covered in 3 and fully endothelialized in all 10 cases assessed Ͼ8 weeks after implantation. In patients stented for inadequate pulmonary flow, ductal intimal hyperplasia occurred by 9 months in all 3 survivors but responded to repeated dilation. Conclusions-Ductal stenting cannot be recommended. In patients with HLH, it provides only short-term palliation even when combined with pulmonary artery banding. With duct-dependent pulmonary blood flow, the procedure carries high risk, and duration of palliation is poor. In patients with bilateral ducts and absent central pulmonary arteries, good palliation may be achieved, but repeated angioplasty is necessary to counteract intimal hyperplasia. (Circulation. 1999;99:2621-2625.)
Objective-To assess the feasibility of pulmonary artery banding, atrial septectomy or septostomy, and percutaneous stenting of the arterial duct in babies with the hypoplastic left heart syndrome. Patients Patients and methods Four neonates (birth weights 3 0, 3 7, 4 1, and 3-3 kg) presented in the first week of life with heart failure caused by mitral and aortic atresia with hypoplasia of the left ventricle. Their parents opted for an attempt at palliation. The babies were treated with intravenous prostaglandin E to maintain duct patency.
SURGERYThree patients underwent the surgical stage of treatment first, the fourth had the surgical stage of treatment after balloon atrial septostomy and ductal stenting. Surgery was undertaken at the ages of 34, 22, 19, and 11 days respectively. A median sternotomy was performed and the proximal right and left pulmonary arteries were banded with nylon tape (coated with Silastic in three cases), each band was held in place by two Ethibond 5-0 sutures; we attempted to reduce the pulmonary artery diameters by approximately 50%. Open atrial septectomy was performed in the first two babies during a brief (approximately 10 minute) episode of circulatory arrest after cooling to 20°C on cardiopulmonary bypass. The operative procedure was similar in each child, but in the second case the duct was dilated peroperatively with a 10
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