Fascia lata composite graft for right ventricular outflow tract and pulmonary artery reconstruction: Surgical technique

Ionescu, Marian I.; Deac, Radu C.

doi:10.1136/thx.25.4.427

Cited by 24 publications

(5 citation statements)

References 13 publications

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“…Experimental studies in dogs by Scavo and Brown et al1° have confirmed that monocusps valves constructed of 0.1 -mm PTFE have less neointimal hyperplasia, less thrombus formation, and less calcification than those constructed of fresh pericardium or gluta raldehyde-f ixed perica rdium. In addition, studies investigating the role of 0.1-mm PTFE as a pericardial membrane to avoid myocardial injury during resternotomy' [1][2][3][4][5][6][7][8][9][10][11][12][13][14] have demonstrated that the membrane has minimal fibroblast infiltration and minimal adhesions with the patients' own tissues. In our series, one patient has limited mobility of the monocusp at 16-month follow-up.…”

Section: Discussionmentioning

confidence: 99%

The Pericardial Membrane Pulmonary Monocusp: Surgical Technique and Early Results

et al. 1985

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Long‐term pulmonary insufficiency resulting from simple transannular patching of the right ventricle outflow tract will ultimately lead to deterioration in right ventricular function. Previously, monocusps constructed from xenografts, homografts, fascia lata, and autologous pulmonary artery wall have been utilized to minimize pulmonary regurgitation and its deleterious effect on right ventricular function. However, these tend to degenerate in the long term, necessitating reoperation. To circumvent this problem we have used a monocusp constructed from 0·1−mm polytetrafluorethylene (PTFE, pericardial membrane) clinically demonstrated to be resistant to issue ingrowth and degeneration. Seven children (5 tetralogy of Fallot, 2 pulmonary stenosis) who required division of a small pulmonary an‐nulus underwent monocusp construction with 0.1‐mm PTFE. Three patients had previous corrective surgery. One of these patients had a bovine pericardial monocusp placed 8 years previously, which degenerated. Of the remaining two patients, one had a pulmonary valvo‐tomy as a neonate, the other repair of tetralogy of Fallot with a transannular patch. At a mean (± standard deviation) follow up to 17 ± 5·8 months all patients are alive and are New York Heart Association (NYHA) Class I. Echocardiography demonstrates mild pulmonary insufficiency (PI) in 2 patients, mild to moderate PI in 4, and moderate to severe PI in 1. The presence of a pericardial membrane monocusp in the pulmonary position may, in the long term, prevent the deleterious effects of transannular patching on right ventricular dysfunction and be more resistant to degenerative changes characteristic of monocusps constructed of native pericardium or allogeneic tissue.

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Section: Discussionmentioning

confidence: 99%

The Pericardial Membrane Pulmonary Monocusp: Surgical Technique and Early Results

et al. 1985

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“…Numerous materials have been used for reconstruction of the pulmonary artery. Pericardium was introduced by Rastelli, Ongley, Davis, and Kirklin (1965), while fascia lata has been advocated by Ionescu and Deac (1970) and Lincoln, Geens, Ross. and Ionescu (1971).…”

Section: Discussionmentioning

confidence: 99%

Recurrent aortopulmonary artery fistula

Buxton¹,

Cooley²

1973

Thorax

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. (1973). Thorax, 28,[521][522][523][524][525]. Recurrent aortopulmonary artery fistula. The case report is presented of a patient who underwent successful repair of a recurrent fistula between the aorta and the pulmonary artery secondary to an atherosclerotic aneurysm of the ascending thoracic aorta. The fistula was situated between the proximal part of the ascending aorta and the proximal part of the main pulmonary artery and was associated with aortic incompetence together with pulmonary valvular stenosis and incompetence. The repair involved prosthetic replacement of both the pulmonary and aortic valves, the main pulmonary artery, and the ascending thoracic aorta.An aortopulmonary artery fistula is a rare complication of an atherosclerotic aneurysm of the ascending thoracic aorta (Nicholson, 1943). A fistula between the thoracic aorta and the pulmonary artery has also been reported following rupture of a dissecting thoracic aneurysm and trauma (Ward and Kalbfleisch, 1968;Bory et al., 1970; Zajtchuk, Resnekov, Ranniger, and Gonzalez-Lavin, 1971). The case report is presented of a patient with a recurrent aortopulmonary artery fistula resulting from rupture of an aneurysm of the ascending thoracic aorta. Corrective treatment included prosthetic replacement of the ascending aorta, aortic valve, pulmonary artery, and pulmonary valve. CASE REPORTA 52-year-old man was asymptomatic until January 1968 when he developed myalgia, fever, chills, and dyspnoea lasting for approximately one week. At that time a cardiac murmur was heard and a diagnosis of subacute bacterial endocarditis was made. On admission to hospital his temperature was 101' F (38°C) and his blood pressure 240/100 mmHg. A continuous machinery-like murmur was heard over the precordium. The patient was treated for subacute bacterial endocarditis although blood cultures were negative. Cardiac catheterization was performed the following month.The pressures and saturations are summarized in the

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“…Our clinical experience with frame-mouned fascial grafts has shown that in a different haemodynaniic situation in the mitral area these grafts perform satisfactorily more than one year after implantation (Ionescu et al, 1970).…”

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confidence: 91%