A Modified Technique for Valve Regurgitation After Partial Atrioventricular Septal Defect Repair.

Given its complex pathologic anatomy, recurrent left atrioventricular valve regurgitation after partial atrioventricular septal defect repair remains a challenge for surgical correction. Here, we introduce a modified bridging technique by shortening the anteroposterior leaflet distance in selected patients with inadequate coaptation to compensate for the short leaflet height, specifically that of the anterior leaflet.

Surgical outcome of isolated total anomalous pulmonary venous connection in adults: a 14-year experience.

AIM OF THE STUDY: To investigate the surgical result of adult total anomalous pulmonary venous connection (TAPVC). METHODS: From March 1997 to March 2011, 12 adult cases of isolated TAPVC, with an average age of 24.9 ± 6.7 years (from 18 to 41 years), underwent surgical repair in our department. All patients suffered from right-sided volume overload with clinical manifestations varying from mild cyanosis to severe heart failure. RESULTS: According to Darling's classification, eight cases were classified as supracardiac type, four as cardiac type. Unobstructed connections were established between the left atrium and the pulmonary common vein in all patients with external cardiac approach in four supracardiac cases, and internal cardiac approach in four cardiac and three supracardiac cases, and Warden technique in one supracardiac patient. Concomitant operations included De Vega's tricuspid annuloplasty in six patients, patent arteriosus ductus closure in two. All patients survived the operation, and postoperative follow-up was 100% complete with a period ranging from 10 months to 14 years. NYHA grade decreased from 2.33 ± 0.49 to 1.08 ± 0.29 (p < 0.01). Three patients had postoperative tricuspid insufficiency. Five patients had cardiac arrhythmia, among two symptomatic cases; one controlled with medication, another received a successful radiofrequency ablation for incision-related atrial flutter. CONCLUSIONS: Surgical correction of isolated adult TAPVC can be carried out safely with acceptable long-term outcome. Postoperative tricuspid insufficiency and cardiac arrhythmias may have a negative long-term impact, which should be evaluated preoperatively and managed individually during surgery.

[Effect of decellularization on tissue composition and immunogenicity of porcine and human aortic valves].

OBJECTIVE: To study the changes of tissue composition and immunogenicity of porcine and human aortic valves after decellularization. METHODS: Three cryopreserved human aortic valves and 4 porcine valves were decellularized with trypsin, and the leaflet tissue was homogenized for SDS-PAGE protein electrophoresis and U-937 migration assay. RESULTS: Trypsin effectively removed the cells from the valve. SDS-PAGE demonstrated an obvious difference in the tissue composition between porcine and human valves. Although decellularization significantly diminished the differences between the valves, decellularized procine aortic valve stilled contained more protein components (between 26 000 and 43 000) than human valve. U-937 migration assay showed an obvious decrease of cell migration in the valves by decellularization (from 832.7×10(3) to 152.4∓31.1×10(3) for porcine valves, P<0.01, and from 644.9×10(3) to 91.2×10(3) for the human valves, P<0.01). Decellularized porcine valves induced a significantly greater cell migration than decellularized human valves (P<0.05). CONCLUSION: Decellularization with trypsin can effectively decrease the immunogenicity of human or porcine heart valve, but can not completely eliminate the antigen, and decellularized porcine valve still retain strong immunogenicity.

[Subcutaneous implantation of tissue-engineered heart valve leaflets in nude mice].

OBJECTIVE: To investigate the viability of tissue-engineered heart valve leaflets prepared with cell-polymer constructs in nude mice. METHODS: Sheep endothelial cells and smooth muscle cells/fibroblasts were seeded on patches of PHA and implanted subcutaneously in athymic mice (BALB/C). The cell-polymer constructs were harvested 12, 14, 21 and 28 days after implantation. RESULTS: Fourteen days after implantation, the cell-polymer constructs exhibited similar color with the autologous tissues, and HE staining showed more numerous cells in the implant. At 28 days following implantation, muscular fibers were formed in the cell-polymer constructs. V-G staining showed positive collagen staining in the implant at 12 days after implantation, while the control implants retrieved 28 days after implantation did not show extensive tissue formation or muscular fiber formation. CONCLUSION: The cell-polymer constructs can survive in vivo and has the potential to grow into autologous valve leaflets in the nude mice.

[Effect of trypsin and Triton-X 100 for decellularization of porcine aortic heart valves].

OBJECTIVE: To test two decellularization procedures for their potential of cell removal and mormal matrix preservation. METHODS: Porcine aortic valve leaflets were treated with either 0.05% trypsin or 0.25% Triton-X 100 respertively for 48 h for decellularization and with fresh untreated valve leaflets as control. Two tissue samples from each group were stained with hematoxylin and eosin and observed light-microscopically followed by scanning electron microscopy. Ten valve leaflets in each group were measured for shrinkage temperature, tensile strength/fracture toughnes and percentage elongation. RESULTS: Trypsin and Triton-X 100 all achieved complete decellularization but Triton-X 100 caused stronger structural alterations. No significant difference was identified between untreated and trypsin groups in shrinkage temperature, tensile strength/fracture toughnes and percentage elongation, but Triton-X 100 group showed significant difference from the other two groups. CONCLUSION: Decellularization using trypsin is superior to Triton-X100 in efficiency and matrix preservation.