An Experimental Study on Transannular Patching of the Right Ventricular Outflow Tract with and without a Pulmonary Valve Monocusp Mechanism

Abstract

The efficacy of a pericardial patch in the right ventricular outflow tract (RVOT) with a monocusp valve mechanism was investigated experimentally. Hemodynamic performance of the right ventricle and angiographic competence of the valve were compared in animals after patching of the RVOT and removal of the pulmonary valve (group I), patching of the RVOT, removal of the pulmonary valve and implantation of a monocusp valve (group II), patching of the RVOT, partial removal of the pulmonary valve and implantation of a monocusp valve (group III) and a control group (IV). Postoperative effective right ventricular cardiac index, stroke volume and stroke work improved significantly from group I to III, but did not reach the control values of group IV. Angiographically the monocusp valve allowed some early diastolic regurgitation due to late closure (group II) if it was not supported by remnants of the animal's own pulmonary valve (group III).

Current Strategy of Repair of Tetralogy of Fallot in Children and Adults: Emphasis on a New Technique to Create a Monocusp‐Patch for Reconstruction of the Right Ventricular Outflow Tract

“…Different methods have been used to create a valve in the pulmonary artery annulus to resume the pulmonary valvular function. This includes valved homograft patch, 3,7 monocusp patch, 5,[13][14][15][16][17][18][19][20][21][22][23][24][25] or reconstructing an autologous competent 3-cusp valve from the native tissues. 26 We have demonstrated that when one pulmonary valve is absent in the pulmonary artery with the normal size, it creates a pulmonary regurgitation with back flow that equals to about half of the forward pulmonary artery flow.…”

“…There are a few types of monocusp patch being used for TOF repair. As reported, monocusps have been constructed from xenografts, homografts, fascia lata, and autologous pulmonary artery, pericardium, 5,[15][16][17][18][19][20][21][22][23][24][25][26] or Gore-Tex valve (W.L. Gore & Associates, Inc., Flagstaff, AZ, USA).…”

“…28 The autologous pericardial valve sewn on another pericardial patch is one of the earliest monocusp patches used clinically. 17,18,23,24 However, it has been reported that this monocusp, although it effectively eliminates the pulmonary insufficiency in early postoperative period, 20 does not prevent pulmonary insufficiency soon after the operation, presumably due to degeneration or absorption of the monocusp. 9,29 Efforts have been made to overcome this problem with a monocusp constructed from 0.1-mm polytetrafluorethylene (PTFE).…”

The current strategy of repair of tetralogy of Fallot in children and adults

“…The second strategy, therefore, is to protect as far as possible the function of the native pulmonary valvar leaflets, or to create a new valve in pulmonary position when the transjunctional repair is inevitable. 13 Different methods have been used to create a new valve, including insertion of a valved homograft patch, 3,7 monocusp patches constructed from xenografts, homografts, fascia lata, autologous pulmonary artery, or pericardium, 5,[14][15][16][17][18][19][20][21][22][23][24][25][26][27] devices made of Gore-Tex, 28 or polytetrafluorethylene, 5,29 creation of a bifoliate polytetrafluoroethylene prosthesis, 30,31 or reconstruction of an autologous and competent trifoliate valve using native tissues. 26 We have recently described our own technique of creating an autologous pericardial monocusp patch containing 2 glutaraldehyde-treated pericardial patches.…”

Double‐Outlet Right Ventricle for Relief of Pulmonic Stenosis in Dogs An Experimental Study

“…[30][31][32][33][34][35][36][37][38][39][40][41][42] Although initial effects of pulmonary insufficiency are well-tolerated, pulmonary insufficiency is probably not a benign lesion. ", 1*, 23,27,[43][44][45][46][47] Except for valve replacement, most intracardiac techniques to relieve valvular pulmonic stenosis cause some degree of valvular insufficiency.…”