ABSTRACT
An 82-year-old man was referred to our hospital because of fever and disequilibrium. Brain magnetic resonance imaging showed acute multiple cerebral infarctions with multiple small intracerebral hemorrhages. The laboratory tests revealed an elevated inflammatory response, and two separate sets of blood cultures were positive for Streptococcus oralis. Transesophageal echocardiography revealed a single site of vegetation (13×11 mm) of the mitral anterior annulus. The vegetation apparently did not involve the intervalvular fibrous body. Moderate mitral regurgitation and mild to moderate aortic regurgitation were detected. Early surgical intervention was considered, but there was a high risk of operative mortality. We thus initially performed only medical treatment. Transesophageal echocardiography was again performed 12 days after his admission and revealed vegetation of the mitral anterior annulus progressing to the aortic annulus via the intervalvular fibrous body. It seemed to be difficult to control this progressive infective endocarditis with medical treatment. We therefore performed a semi-urgent operation. With an incision into the right-side left atrium, we identified the vegetation of the center of the mitral anterior leaflet progressing to the mitral anterior annulus. Subsequently, we added an aortotomy with Manouguian’s incision. We were able to remove all vegetation that was present in the aortic annulus, intervalvular fibrous body, and mitral annulus with a Commando operation. Finally, we performed double valve replacement with reconstruction of the intervalvular fibrous body and other lost cardiac structures using one boat-shaped bovine pericardial patch. He was discharged to home 34 days after surgery with no neurological complications and no recurrence of infective endocarditis. He also had no recurrence of infective endocarditis and no paravalvular leakage on either prosthetic valve at one year after the surgery.
ABSTRACT
A 53-year old female was noted to have an enlarged heart on a medical checkup. A multislice computed tomography study demonstrated a giant coronary artery aneurysm measuring 10 cm in diameter and a coronary arteriovenous fistula, both located below the left atrium. Resection of the aneurysm and ligation of the feeding arteries and arteriovenous fistula were performed under cardiopulmonary bypass. As the native coronary sinus was occluded, we reconstructed the vessels draining from the aneurysm into the right atrium with an autologous pericardial patch to preserve the coronary venous blood flow. To our knowledge this is the first report of an autologous pericardial patch being successfully used to reconstruct the coronary venous flow during surgical treatment of a giant coronary artery aneurysm with a coronary arteriovenous fistula.
ABSTRACT
Here, we present a case of successful aortic valve repair of traumatic aortic regurgitation (AR). A man in his early twenties had a chest blunt trauma due to a bicycle accident 6 years earlier and suffered sternum fracture. He recovered without cardiovascular complications. Three months previously, a new diastolic murmur was detected on medical checkup. Transthoracic echocardiography (TTE) showed severe AR, and the left ventricular end-diastolic-/end-systolic dimension was 69/51 mm. Transesophageal echocardiography showed severe AR with perforation of the non-coronary cusp and dilatation of the aortic annulus (29.6 mm). Aortic valve repair was performed with an autologous pericardial patch and external suture annuloplasty. Postoperative TTE showed normal aortic valve function with trivial AR. He was discharged on postoperative day 11. Three months later, TTE showed trivial AR along with a reduced left ventricular dimension and improved left ventricular ejection fraction.
ABSTRACT
Breast reconstruction is an essential part in the comprehensive management of breast cancer. The clinical application of patches (e.g., acellular dermal matrix, ADM) is the most impactful innovation in implant breast reconstruction in recent years. The wide application of patches in implant breast reconstruction promotes the development of immediate prosthetic reconstruction, im-proves the aesthetic outcomes of reconstructed breasts, and avoids additional donor tissue damage caused by autologous flap breast reconstruction. At present, patches used in breast reconstruction are mainly ADMs, bovine pericardial patches, and TiLOOP, which are widely used because of their good histocompatibility and tissue defect repair ability. This article reviews the applications and research statuses of these patches.
ABSTRACT
Objective To investigate the activity of autologous pericardial patch treated by distilled water in right ventricular outflow tract reconstruction of tetralogy of fallot,and to evaluate its clinical effect. Methods The study used 125 patients who had applied correction surgery of tetralogy of fallot and autologous pericardial patch treated by distilled water in the right ventricular outflow reconstruction. 39 cases used fresh autologous pericardial patches,and 86 cases used autologous valved pericardial patch. The degree of insufficiency and activity of the pulmonary valve were compared. Results The mean follow-up time was ( 63 ± 8 ) months in fresh autologous pericardial patches group, while (55 ± 7) months in valved patch group. No significant difference was found in age, body surface area, heart rate, pulmonary artery diameter, cardiopulmonary bypass time and priming volume postoperative between the two groups. The exacerbations of pulmonary valve insufficiency and activity in fresh autologous pericardial patches group were significantly higher than in valved patch group. Conclusion Autologous pericardial patch treated by distilled water was beneficial in right ventricular outflow tract reconstruction of tetralogy of fallot. It reduced pulmo-nary valve insufficiency and sclerosis after the correction surgery and showed good mid-term clinical results .
ABSTRACT
A 71-year old woman, who underwent direct closure of an atrial septal defect with mild tricuspid regurgitation (TR) 18 years previously, suffered terminal cardiac failure with extreme cardiomegaly, mitral regurgitation and severe TR. Medical treatment gradually became ineffectual and we decided to perform surgical therapy. Mitral annuloplasty with a prosthetic ring, tricuspid valve repair, plications of extended bilateral atrium walls and epicardial ventricular pacemaker implantation were performed. In tricuspid valve repair, anterior tricuspid leaflet was augmented by use of glutaraldehyde-preserved autologus pericardial patch and tricuspid annuloplasty with addition of a slightly larger prosthetic ring. Atrio-ventricular regurgitations disappeared and she was discharged 63 days after the operation. Valve extension is a very effective technique to treat severe secondary TR, and long term follow-up is necessary.
ABSTRACT
BACKGROUND: In cardiac surgery, especially in the reconstruction of vascular structures and intracardiac defects, glutaraldehyde has usually been used as the reagent for fixing porcine or bovine pericardial tissues. But the well-known problem of calcification or cytotoxicity of glutaraldehyde motivates the search for a replacement. The aim of this study is to investigate the physical, mechanical, and biochemical characteristics of bovine pericardial tissues fixed with genipin, which is known to be a less toxic and more natural fixing reagent. MATERIALS AND METHODS: Bovine pericardial tissues were fixed with different concentrations and conditions of glutaraldehyde and genipin. To determine the physical, mechanical, and biochemical differences among different concentrations and conditions, we divided the tissue into 18 groups by concentration, the addition of organic solvents, and the timing of adding the organic solvents, and compared the characteristics of each group. RESULTS: Tensile strength, physical activity, and thermal stability tests revealed that the tissues fixed with glutaraldehyde were better with regard to mechanical strength and biochemical durability. However, the difference was not significant statistically. CONCLUSION: Genipin can be used as an alternative crosslinking agent for pericardial tissue, considering given its physical, mechanical, biochemical characteristics and low cytotoxicity comparable to glutaraldehyde. However, further studies are needed on the immune reaction and the long term changes in genipin-fixed tissues in the human body.
Subject(s)
Bioprosthesis , Glutaral , Human Body , Iridoids , Motor Activity , Solvents , Tensile Strength , Thoracic Surgery , Transplantation, HeterologousABSTRACT
Superior type of sinus venosus atrial septal defect (SVASD) is invariably associated with the unroofing of right upper pulmonary vein (RUPV). Warden procedure and pericardial patch repair with rerouting of the RUPV are commonly performed operations for the superior SVASD. Both operations involve the risk of obstruction to the flow of superior vena cava or rerouted pulmonary vein in the postoperative period. The sinus venosus defects are well visualized on the transesophageal echocardiography (TEE) because of the proximity of the TEE probe to these structures. We are reporting two cases operated for the superior SVASD with unroofed RUPV, highlighting the intraoperative echocardiographic features before and after the surgery.
Subject(s)
Child, Preschool , Echocardiography, Transesophageal , Female , Heart Septal Defects, Atrial/surgery , Heart Septal Defects, Atrial/diagnostic imaging , Humans , Monitoring, Intraoperative , Vena Cava, Superior/abnormalitiesABSTRACT
OBJECTIVES: A duplex ultrasound study was performed to investigate morphological and hemodynamic patterns of carotid stenoses treated by endarterectomy with patch closure versus stenting. MATERIALS AND METHOD: Twenty-nine carotid stenoses were treated with stenting and 65 with patch closure. Duplex ultrasound parameters (luminal diameter, mm; peak systolic velocity and end-diastolic velocity, cm/s) were measured 24 hours after the procedures and also at 12 months post-procedure. Residual stenoses (immediately postprocedure) and restenoses (within 12 months of procedure) were defined as narrowings of >50 percent on duplex ultrasound examination. RESULTS: In stented patients, the luminal diameter of the proximal internal carotid artery increased in the interval between the 24-hour and 12-month post-procedure studies, while in the patch closure patients, the diameter decreased. Carotid hemodynamics normalized immediately after both patching and stenting and remained relatively stable thereafter up to 12 months. No statistically elevated flow velocities (in the absence of residual stenosis or restenosis) were observed in the patched or stented carotid arteries. No significant differences in residual stenosis rates were observed between the stenting group (3 cases, 10.34 percent) and the patch closure group (1 case, 1.53 percent, P = 0.08). At 12 months, 2 stenting patients (6.88 percent) and 2 patch closure patients (3.07 percent) had $50 percent restenosis (P = 0.58). One case of late stroke due to restenosis was observed in the stenting group; the patient died 12 months postoperatively, before receiving new intervention. CONCLUSION: Measurements over time in luminal diameter signalized differences in arterial remodeling mechanisms between patched and stented carotids. Both stenting and patch closure were associated with carotid patency and flow restoration. This study does not support a general approach to new velocity criteria indiscriminately applied to stented or patched carotids.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Carotid Artery, Internal , Carotid Stenosis , Endarterectomy, Carotid/methods , Hemodynamics/physiology , Blood Vessel Prosthesis , Chi-Square Distribution , Carotid Artery, Internal/physiopathology , Carotid Artery, Internal/surgery , Carotid Stenosis/physiopathology , Carotid Stenosis/surgery , Stents , Treatment Outcome , Ultrasonography, Doppler, DuplexABSTRACT
Objective: Slide tracheoplasty seems to be the most efficient surgical procedure for correcting long-segment funnel-shaped congenital tracheal stenosis. However, in cases of extremely long-segment or those involve carina, slide tracheoplasty when operated alone has certain degree of limitations which often need additional operative procedure. The authors report a technique of slide tracheoplasty in combination with pericardial patch augmentation in a child with congenital tracheal stenosis involving the carina. Methods: A 3-month-old girl, previously diagnosed with Tetralogy of Fallot and congenital tracheal stenosis, presented with severe cyanosis and serious major airway obstruction after a few days of upper respiratory tract infection (URI). Because of the failure to maintain her ventilation with a high positive pressure ventilator, an emergency slide tracheoplasty with a modified right Blalock’s Taussig shunt was performed under a cardiopulmonary bypass. The intraoperative finding revealed a complete tracheal ring stenosis involving the lower half of the trachea and carina. It was transected at the middle and a vertical incision was made at the posterior wall of the upper trachea and anterior wall of the lower and extended into orifices of the main bronchus. The upper and lower tracheal flaps were slid together and sutured with interrupted Proline 5-0. Consequently, she still had significant obstruction of the main bronchi postoperatively and needed a re-operation two days later. Under cardiopulmonary bypass support, the lower anastomotic sutures were removed and an additional bronchial incision was made into the main bronchus. The anterior upper tracheal flap was separated into two, and each equal flap was pulled down and sutured to the main bronchus. Then an autologous pericardial patch was used to cover all the airway defects. Intraoperative fiberoptic bronchoscopy demonstrated adequate tracheo-bronchial lumen. Results: The child had postoperative hyperactive airway reaction and needed prolonged ventilator support and tracheostomy for tracheal toileting. Repeated postoperative bronchoscopy found moderated granulation tissue which was easily removed by catheter suction. Unfortunately, the patient expired six months after the surgery due to uncontrolled sepsis. However, a bronchoscopic finding before the patient’s death revealed adequate major airway patency. Conclusion: Combined slide tracheoplasty with pericardial patch augmentation made reconstruction of the complex congenital tracheal stenosis involving carina or tracheal bronchus possible and minimized the result of unflavoric excessive granulation tissue forming caused by pericardial tracheoplasty alone.
ABSTRACT
A 60-year-old female was admitted to our hospital complaining of dyspnea.In the past history,she had received tracheal diversion due to recurrent aspiration after brain surgery and tracheostomy.Emergency three dimensional spiral tracheal computed tomograhpy revealed distal tracheal stenosis.The operation was performed by anterior tracheoplasty using glutaraldehyde-soaked autologous pericardium through median sternotomy.Herein we report a case of anterior tracheoplasty using glutaraldehyde-soaked autologous pericardium.
Subject(s)
Female , Humans , Middle Aged , Brain , Glutaral , Pericardium , Tracheal StenosisABSTRACT
BACKGROUND: Various bronchoplastic procedures have been attempted in patients with long segmental bronchial stenosis, but it is still not clear which procedure is the best method for restoring bronchial patency. MATERIAL AND METHOD: To study the feasibility of designed patch as a bronchial substitute in bronchoplastic procedure, 10 experimental dogs of each 5 were divided into two groups according to the different patches applied. In group A (n=5), 0.5X0.5 cm sized rectangular defects were created on ventral aspect of left main bronchus and were then covered with patches made of costal cartilage mounted autologous pericardium. In group B(n=5), same sized bronchial defects were created and covered by patches made by glutaraldehyde treated bovine pericardium. Dogs were sacrificed on the twelfth weeks after bronchoplasty and the macroscopic and microscopic findings were examined. RESULT: In group A, external surface of grafted patches revealed some membranous adhesions with surrounding connective tissue and the margin of patches were smoothly incorporated into native bronchial wall. The bronchial lumen kept good integrity without stenosis and preserved the glistening mucosa well. Formation of new transitional epithelial bridging between native bronchial wall and grafted patches with tiny scattered granulation tissues were present. In group B, external surface of grafted patches were brownish shrunken with partial collapse of bronchial lumen. Inner surface showed dirty granulation at the edge of native bronchus and grafted patches with intermingled hemorrhages. New epithelial growth into the patches had not occurred. CONCLUSION: These results suggest that costal cartilage mounted autologous pericardial patches could be considered as one of the appropriate bronchial substitutes for covering bronchial defects since it maintains bronchial stability and forms epithelial bridging with native bronchus.
Subject(s)
Animals , Dogs , Humans , Bronchi , Cartilage , Connective Tissue , Constriction, Pathologic , Glutaral , Granulation Tissue , Hemorrhage , Mucous Membrane , Pericardium , TransplantsABSTRACT
BACKGROUND: Calcific degeneration is unavoidable in either homo or heterografts implanted in the human body. We have developed a calcification-resistant cardiovascular tissue patch using a novel technique of anticalcification. MATERIALS AND METHODS: Fresh bovine pericardium was harvested at the slaughter house and transfered to the laboratory in Hank's solution. After trimming and fixing the pericardium, it was embedded in 4degree C 0.65% glutaraldehyde for a week and then washed by phosphate-buffered saline (PBS) of pH 7.4. This prepared pericardium was then stored in 2.5% sulphonated polyethyleneoxide (PEO-SO3) solution for 2 days at room temperature and reversed by 4degree C NaBH4 solution for 16 hours. To evaluate the calcification-resistance of surface modified bovine pericardium with PEO-SO3, either glutaraldehyde-treated (GA group, n=4) or PEO-SO3-treated pericardial patch (PEO-SO3 group, n=4) was implanted into adult mongrel dog to reconstruct the main pulmonary artery and the descending aorta using a partial clamp technique. After 1 month follow-up, the implanted patches were retrieved to evaluate the pathologic findings and the content of calcium and phosphorous. RESULTS: The PEO-SO3 group showed substantially less retraction and significantly less calcium deposition than the GA group in both aortic (7.10+/-1.05 vs. 13.81+/-2.33 mg/g of dried tissue) and pulmonary positions (1.55+/-0.29 vs. 6.72+/-0.70 mg/g) (p<0.01). Phosphorous contents were also less in the PEO-SO3 group than the GA group significantly, 8.11+/-1.07 mg/g vs. 19.33+/-4.31 mg/g in the aortic and 2.58+/-0.40 vs. 12.60+/-3.40 mg/g in thepulmonary position (p<0.01). CONCLUSIONS: These findings suggest that PEO-SO3 modified bovine pericardium is highly calcification-resistant but further study is needed to evaluate the long-term biological safety and compatibility of the prosthesis.
Subject(s)
Adult , Animals , Dogs , Humans , Aorta , Aorta, Thoracic , Calcinosis , Calcium , Follow-Up Studies , Glutaral , Heterografts , Hominidae , Human Body , Hydrogen-Ion Concentration , Pericardium , Polyethylene Glycols , Prostheses and Implants , Pulmonary ArteryABSTRACT
BACKGROUND: Calcific degeneration limits durabilities of the bioprosthetic tissues implanted in the human body. The direct coupling sulphonated polyethyleneoxide (PEO-SO3) to the bioprosthetic tissues after glutaraldehyde (GA) fixation and the removal of residual aldehyde groups from the tissues can augment the effect of calcification-resistance. MATERIALS AND METHODS: To study the anti-calcification effect by PEO-SO3 modification and the removal of the residual aldehyde groups of tissues, surface modified bovine pericardia (BP-PEO-SO3) were preserved in aseptic saline to wash out GA (saline group) and 0.65% GA solution (GA group). And then above two groups and PERIGUARD (Bio-vascular. Co.) (product group) were evaluated with respects to calcium contents and microscopic findings using in vivo implantation models at carotid and femoral artery and peritoneum of 8 adult dogs. RESULTS: In the tissues retrieved from carotid artery, calcium content was significantly decreased in saline group than in other two groups (saline; 2.89+/-0.31 vs. GA; 6.14+/-1.08 vs. product; 22.82+/-5.00 mg/g of dried tissue; p<0.05). In the tissues retrieved from femoral artery and peritoneum, calcium amount was also decreased in saline group than in other two groups, but not reached the significant difference between groups. On the other hand, the pathologic findings of pericardial tissues showed marked destructuction in GA group compared to the other two groups. CONCLUSIONS: In this study, covalently PEO-SO3 bound to bovine pericardium decreased calcifications and the anti-calcification effect of BP-PEO-SO3 could be augmented by the washing out the residual aldehyde groups using saline after GA fixation. Conclusively, the PEO-SO3 modified bovine pericardium is highly resistant to calcification and can be useful for the development of calcification-resistant cardiovascular patches and valves.
Subject(s)
Adult , Animals , Dogs , Humans , Arteries , Calcinosis , Calcium , Carotid Arteries , Femoral Artery , Glutaral , Hand , Human Body , Pericardium , Peritoneum , Polyethylene GlycolsABSTRACT
Congenital long-segment tracheal stenosis with complex cardiac anomaly has generally been regarded as a fatal disease. This report described the successful concomitant repair of unexpected congenital tracheal stenosis and complex cardiac anomaly with the use of cardiopulmonary bypass. The patient was a 3-month-old girl with coarctation of aorta, VSD, and PDA. The presence of tracheal stenosis was not discovered until when difficulty with endotracheal intubation was encountered at operating room. Thus, we decided concomitant repair of both lesions and performed anterior pericardial tracheoplasty combined with one stage repair of coarctation of aorta, VSD, and PDA under the cardiopulmonary bypass. The patient is doing well without any signs of complication at present, 2 years and 1 month after the operation.
Subject(s)
Female , Humans , Infant , Aortic Coarctation , Cardiopulmonary Bypass , Heart Defects, Congenital , Intubation, Intratracheal , Operating Rooms , Tracheal StenosisABSTRACT
Long, severe, and fixed congenital tracheal stenosis is a life-threatening anornaly and not relieved by endotracheal or tracheostomy intubation. The rarity of congenital tracheal stenosis has not allowed sufficient experience for the development of standard treatment methods, therefore, congenital tracheal stenosis still carries significant morbidity, with a mortality rate as high as 70%. We have followed up two patients managed by different methods, but O(2)-isoflurane-Fentanyl-vecuronium was used for induction and maintenace. We experienced one case of tracheoplasty with pericardial patch for extensive tracheal stenosis under extracorporeal circulation, and one case of slide tracheoplasty for funnel-shaped tracheal stenosis. The first case was noticed incidentally during anesthetic induction and the vocal cord was visible but 2.5 mm sized tube could not be advanced,so we used the guide wire which is used for central line, then we could intubate with some resistance. Tracheostomy was not allowed due to diffuse tracheal stenosis reaching from cricoid cartilage to carina. During the extra corporial circulation, the guide wire was inserted from operation field, and 3.5 mm sized tube was introduced via guide wire by anesthesiologist. After operation the grannulation tissue that obstructing airway, was noticed by bronchoscopy, and was removed, then he was weaned from ventilator successfully. The second case was discovered due to diffcult weaning from ventilator after open heart surgery. the bronchogrm showed right tracheal bronchus and diffuse tracheal stenosis from T2 to carina. He was ventilated initially with 4.0 mm sized endotracheal tube, and ventilated intermittently with other 2.5 mm sized endotracheal tube from operation field during tracheal anastomosis. After operation, he died with increased airway pressure and airway bleeding.