Viability of autologous fascia lata in heart valve replacements

Abstract

A histological and radioautographic examination of 11 autologous fascia lata heart valves used in man is described. There was a significant decrease, exponential with time, in the number of fibroblasts per unit volume (P<0 001). The collagen bundles were grossly disorganized and separated, suggesting a breakdown of the cross-linkage in the tissue. Redundant connective tissue on the surface of the valve cusp became oedematous and contained many trapped cells. A pseudoendothelium was formed within 10 days. Incorporation of tritium-labelled thymidine in the nuclei of the fibroblasts showed a sixfold reduction over 9 to 12 weeks following implantation, suggesting a failure of metabolism in these cells. The suitability of fascia lata for human heart valve replacement is discussed.The construction of heart valve substitutes from autologous fascia lata using differing techniques has now become a well-established routine in many centres (Senning, 1967;Ionescu and Ross, 1969;Ionescu, Ross, Deac, Grimshaw, Taylor, Whitaker and Wooler, 1970). Probably the technique most commonly used is one where the fascia lata is sewn on to a supporting threepronged stent for ease of fabrication and insertion (Ionescu and Ross, 1969).In a recent review of 76 patients who had undergone mitral valve replacement with a framemounted fascia lata valve, concern was expressed at the finding of contraction of the cusps of three of these fascia lata valves, with ensuing incompetence (Lincoln, Balcon, Emanuel, McDonald, Muir, Ross, Somerville, and Taylor, 1970). Because of these findings, a study was carried out on frame-mounted fascia lata valves which, for a variety of reasons, had been removed from patients in whom they had been inserted. MATERIAL 1. Fascia lata taken from two patients, A and B, who were undergoing cardiac surgery was made into routine histological sections and stained with haematoxylin and eosin, and these were used as controls. From 11 patients, C to M, sections of valves which had been inserted for periods of time ranging from two days to 32 weeks were also made into histological sections and stained with haematoxylin and eosin.2. Fascia lata from patient B was divided into two parts. One part was immediately fixed in 10% formalin in 0-1 M phosphate buffer, and the other part was left unfixed. Parts of both were prepared for radioautography. Fascia lata from patient I, who had had a valve in situ for nine weeks, and from patient J, who had had a valve in situ for 12 weeks, was prepared for radioautography. The time lapse which occurred between removing the fascia lata from the patients and its special preparation for these studies never exceeded 30 minutes. METHODSRadioautography can give information regarding the growth rate of cells by their ability to incorporate tritium(H3)-labelled precursors of DNA.A modification of the radioautographic technique of Kopriwa and Leblond (1962) was used. This technique is as follows:1. Samples of fascia lata were incubated at 37°C for 48 hours in Eagles Minimum Essential Medium to which ...

Use of Fascia Lata Autograft for Augmentation of Bladder in Rabbits

“…Autogenous FL graft not is cost effective, harvested easily and at sufficient amounts with minor operation site disturbance and functional defect at the donor site, and also no sign of immunological reaction and tissue rejection at recipient site. In view of these properties of the FL graft (2,7,14) we think that it is a suitable graft material that can be used to provide the urinary bladder to its normal capacity.…”

Natural history of fascia lata valves in the aortic and mitral positions

“…The decrease in numbers of viable fibroblasts with the passage of time has been the subject of an earlier communication (Lincoln et al, 1971) There was no evidence that the natural history of the valves was altered in any way by the use of long-term anticoagulants in the few instances when these were used.…”

Pathology of the formalin-treated heterograft porcine aortic valve in the mitral position

“…It was hoped that a living autologous fascia lata valve would retain the advantages of the pig valve, while possessing a greater inherent durability by virtue of its living fibroblasts. However, recent reports (Lincoln et al, 1971;Welch, Potvliege, and Primo, 1971) reveal that the autologous fascia lata valve is imperfect. Depletion of fibroblasts and degenerative changes in the collagen of the transplanted fascia have been noted.…”