Pericardial Monocusp for Pulmonary Valve Reconstruction: A New Technique

Pande, Shantanu; Agarwal, Surendra Kumar; Majumdar, Gauranga; Chandra, Bipin; Tewari, Prabhat; Kumar, Sudeep

doi:10.1177/0218492310369185

Cited by 20 publications

(20 citation statements)

References 19 publications

(15 reference statements)

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“…The intermolecular collagen cross-linkages were suggested to play an important role in initiating autologous pericardium mineralization [22]. The blood flow dynamics in the pulmonary position were implied to be easy to induce the autologous pericardium degeneration [23]. Our early results also advocated the above findings; namely that 0.1 mm ePTFE was associated with a lower incidence of failure than autologous pericardium.…”

Section: Discussionmentioning

confidence: 56%

0.1 mm ePTFE versus autologous pericardium for hand-sewn trileaflet valved conduit: a comparative study

Zhang

Chen

et al. 2019

J Artif Organs

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A hand-sewn trileaflet valved conduit is reportedly better than a bovine jugular graft. However, the comparative efficacy and safety between 0.1 mm ePTFE and autologous pericardium in this surgical procedure remained undetermined. This single-center cohort study included 46 patients aged 3–146 months who received implanted simplified hand-sewn trileaflet valved conduits: 31 patients (Group A) received 0.1 mm ePTFE valved conduits and 15 patients (Group B) received autologous pericardium valved conduits. Perioperative and follow-up outcomes up to 3 years after the surgeries were evaluated. No perioperative complications or early mortality were observed in either group, while one Group A patient aged 46 months died 6 months after surgery due to residual ventricular septal defect. No patients in Group A developed severe regurgitation or stenosis in valves of the conduits, but two moderate stenosis by echocardiography, and seven patients in group B were deemed to be conduit dysfunction (two stenosis, three stenosis plus regurgitation, and the remaining two regurgitation). No conduits failure was detected in group A, while two patients in group B (one for severe stenosis and the other one for severe regurgitation). After 6, 12, and 36 months, 95.2%, 88.9%, and 88.9% of Group A patients and 92.3%, 68.4%, and 42.7% of Group B patients were free from valved conduit dysfunction. After the same follow-up periods, all Group A patients had no conduit failure and 92.3%, 80.8%, and 80.8% of Group B patients were free from valved conduit failure. Within the 3-year follow-up period, 0.1 mm ePTFE novel simplified hand-sewn trileaflet valved conduits appear to be associated with a lower incidence of graft failure than autologous pericardium valved conduits.

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Section: Discussionmentioning

confidence: 56%

0.1 mm ePTFE versus autologous pericardium for hand-sewn trileaflet valved conduit: a comparative study

Zhang

Chen

et al. 2019

J Artif Organs

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“…Although monocusp was created on calculations, yet the design heavily relied on handcrafting; hence, it may have contributed to insufficiency. [12]…”

Section: Discussionmentioning

confidence: 99%

“…This leaflet with the help of posteriorly placed native leaflets creates a competent pulmonary valve at the position of new enlarged annulus. [12]…”

Section: Methodsmentioning

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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“…Current surgical techniques to preserve the pulmonary valve in RVOT reconstruction require excellent demonstration of pulmonary valve anatomy. 15 This is seldom reliably achieved by TTE. In our series, bicuspid pulmonary valve (Figure 7) was picked up by MDCT in 12 patients, and confirmed in all cases by surgical inspection; this information was obtained by TTE in only 4 patients.…”

Section: Discussionmentioning

confidence: 99%

Computed tomographic angiography in tetralogy of Fallot

Kasar

Radhakrishnan

Varghese

et al. 2011

Asian Cardiovasc Thorac Ann

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Echocardiography is often inadequate for imaging tetralogy of Fallot, prompting cineangiography. This study prospectively evaluated multidetector computed tomographic angiography for preoperative evaluation of tetralogy of Fallot in 112 consecutive patients. Forty-eight had nonconfluent or hypoplastic pulmonary arteries (mean z-score, -2; range, -11.1-0.13) permitting only palliative or no surgery; 64 had adequate pulmonary artery anatomy (mean z-score, 0.59; range, -2.53-3.4) allowing total repair. The surgical data of 50 patients who underwent total correction were compared with transthoracic echocardiography and multidetector computed tomographic angiography findings. Multidetector computed tomographic angiography tended to reveal unsuspected collaterals and coronary abnormalities besides outlining the right ventricular outflow tract and pulmonary artery branches. The branch pulmonary artery diameter z-score was the most important determinant of surgical strategy, with the worst figures being associated with no surgical options or palliative surgery, and the best figures leading to corrective surgery. The mean radiation dose was 3.45 mSv. Multidetector computed tomographic angiography is a powerful supplement to echocardiography in the preoperative evaluation of tetralogy of Fallot.

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Pericardial Monocusp for Pulmonary Valve Reconstruction: A New Technique

Cited by 20 publications

References 19 publications

0.1 mm ePTFE versus autologous pericardium for hand-sewn trileaflet valved conduit: a comparative study

0.1 mm ePTFE versus autologous pericardium for hand-sewn trileaflet valved conduit: a comparative study

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

Computed tomographic angiography in tetralogy of Fallot

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