Reoperations in adults with congenital heart disease: analysis of early outcome.

Objectives: The long-term behavior of the pulmonary autograft in the aortic position (Ross procedure) remains uncertain. Using threedimensional (3D) sonomicrometry (200 Hz) we compared the dynamics of the aortic and pulmonary roots. Methods: Twenty-four crystals were implanted in each aortic (eight sheep) and pulmonary roots (six sheep) at: base (3 £ 2), commissures (3 £ 2), sinotubular junction (3 £ 2), ascending aorta (3) and pulmonary trunk (3). Under stable hemodynamic conditions, geometric changes were time-related to left ventricular pressure (LV) and aortic pressure. Results: The expansion of the aortic root is twice that of the pulmonary root. During the cardiac cycle, the aortic root volume increased by 37:7 ^ 2:7% (mean ^ SEM) versus 20:9 ^ 1:0% for the pulmonary root. Both were cone-shaped at end diastole. Because expansion at commissures was twice that of the base, both roots became more cylindrical during ejection. Although both roots started to expand prior to ejection and reached maximal expansion during the first third of ejection, the commissural and sinotubular junction dynamics were different in each root. While in the aortic root, expansion at commissural and sinotubular junction levels was significantly different (63:7 ^ 3:6% versus 37:0 ^ 2:1%), in the pulmonary root, they were similar (29:0 ^ 1:3% versus 27:7 ^ 1:4%). Expansion of the three sinuses was also different ðP , 0:001Þ. In the aortic root: the right expanded more than the left and more than the non-coronary sinus. In the pulmonary root: the right sinus expanded more than the anterior more than the left. Conclusions: Dynamic differences might explain the global pulmonary root dilatation when subjected to systemic pressure, particularly at the level of the sinotubular junction which might result in the autograft failure. Differences in the asymmetrical expansion of the aortic and pulmonary roots should be considered for the implantation of the pulmonary autograft in the most physiological position. q 2002 Elsevier Science B.V. All rights reserved.

/pdf/aortic-and-pulmonary-root-are-their-dynamics-similar-3zxpxsgerj.pdf

Aortic and pulmonary root: are their dynamics similar?

Fontan operation with a viable and growing conduit using pedicled autologous pericardial roll: serial changes in conduit geometry.

Long-term Performance of Fresh Autologous Pericardium for Mitral Valve Leaflet Repair

Background In the past, successful use of decellularized xenogenic tissue was shown in the pulmonary circulation. This study, however, evaluates a newly developed decellularized equine pericardial patch under high pressure circumstances. Material and methods Seven decellularized equine pericardial scaffolds were implanted into the descending aorta of the juvenile sheep. The implanted patches were oversized to evaluate the durability of the decellularized tissue under high surface tension (Law of Laplace). After 4 months of implantation, all decellularized patches were inspected by gross examination, light microscopy (H&E, Serius red, Gomori, Weigert, and von Kossa straining), and immunohistochemical staining. Results The juvenile sheep showed fast recovery after surgery. There was no mortality during follow-up. At explantation, only limited adhesion was seen at the surgical site. Gross examination showed a smooth and pliable surface without degeneration, as well as absence of aneurysmatic dilatation. Light microscopy showed a well preserved extracellular scaffold with a monolayer of endothelial cells covering the luminal side of the patch. On the outside part of the patch, a well developed neo-vascularization was seen. Host fibroblasts were seen in all layers of the scaffolds. There was no evidence for structural deterioration or calcification of the decellularized equine pericardial scaffolds. Conclusions In the juvenile sheep, decellularized equine tissue showed no structural deterioration, but regeneration and remodeling processes at systemic circulation.

https://www.basic.medscimonit.com/download/freeIp/idArt/889915

Successful implantation of a decellularized equine pericardial patch into the systemic circulation.

Behavior of vital and killed autologous pericardium in the descending aorta of sheep.

Expanding indications for the Ross procedure.

A simple device for in vitro assessment of aortic surgery on an isolated heart or aortic root specimen is described. This device was designed as a simple tool to provide surgeons with immediate and direct visual feedback on the results of a procedure performed on the aortic valve in an isolated cardiac specimen. The objectives were to assess the duration of learning new aortic surgical procedures and to instill a greater sense of confidence to the surgeon prior to operating on a patient. Free-hand pericardial aortic valve reconstructions were performed on 9 pig hearts and 5 human homografts, which were tested with this device. In the pig, valve reconstruction was tested using the whole heart as well as the isolated aortic root. Detailed qualitative and quantitative assessments of the performance of the reconstructed aortic valve were possible using this device.

Hong He Luo

Papers

Behavior of vital and killed autologous pericardium in the descending aorta of sheep.

Expanding indications for the Ross procedure.

In Vitro Self-Training in the Surgical Technique of Aortic Valve Repair and Reconstruction