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Background
Despite the improved outcome in complete atrioventricular septal defect (AVSD) repair, reoperations for left atrioventricular valve (LAVV) dysfunction are common. The aim of this study was to evaluate the effect of fresh untreated autologous pericardium for ventricular septal defect (VSD) closure on atrioventricular valve function and co...
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Introduction: The autologous pericardium, treated or fresh, is used in reconstructive
cardiovascular surgery. We aimed to describe the features of fresh pericardium utilized in right
ventricular outflow tract (RVOT) reconstruction, years after the initial surgery.
Methods: This cross-sectional study was performed on 72 patients (65.3% male, mean
ag...
Citations
... In fact, we used to apply the bovine pericardial patch to other neonatal cases with coarctation of the aorta plus VSD, in which the pathophysiology and postoperative condition are similar to IAA/VSD; however, we haven't seen any comparable complications so far. It was also demonstrated that there were no differences on the manifestation between autologous and xeno-pericardium in published articles [21,22]. ...
Background
Intracardiac thrombosis (ICT) is a rare complication after the cardiopulmonary surgery for interrupted aortic arch (IAA) or total anomalous pulmonary venous connection (TAPVC) without previous records. There are still no general guidelines regarding as the mechanism or management of postoperative ICT in neonates and younger infants.
Case presentation
We reported the conservative and surgical therapies in two neonates with intra-ventricular and intra-atrial thrombosis after the anatomical repair for IAA and TAPVC, respectively. There were no risk factors for ICT in both patients, except for the use of blood product and prothrombin complex concentrate. The surgery was indicated after TAPVC correction due to the worsening respiratory status and rapidly decreased mixed venous saturation. Anticoagulation combined with antiplatelet therapies was adopted in another patient. These two were both finally recovered, and three-month, six-month, and one-year follow-up echocardiography revealed no abnormality.
Conclusions
ICT is uncommon in pediatric population after the surgery for congenital heart disease. Single ventricle palliation, heart transplantation, longer central line use, post-extracorporeal membrane oxygenation, and massive blood product use are major risk factors for postcardiotomy thrombosis. The causes of postoperative ICT are multifactorial, and the immaturity of thrombolytic and fibrinolytic system in neonates may serve as a prothrombotic factor. However, no consensus reached regarding as the therapies for postoperative ICT, and the large-scale prospective cohort study or randomized clinical trial is needed.
... [1] Rarely, these patches become redundant and show aneurysmal deformation. [2][3][4][5][6] Pericardial patch-defect size mismatch and large-sized patches have been proposed as the major risk factors for developing a pericardial patch aneurysm. [3][4][5][6] As such, autologous pericardium is less user-friendly than other patch materials because it is sticky and lacks stiffness. ...
... [2][3][4][5][6] Pericardial patch-defect size mismatch and large-sized patches have been proposed as the major risk factors for developing a pericardial patch aneurysm. [3][4][5][6] As such, autologous pericardium is less user-friendly than other patch materials because it is sticky and lacks stiffness. It has to be properly sized to prevent aneurysmal dilatation. ...
... It has to be properly sized to prevent aneurysmal dilatation. [6] This patient developed a large patch aneurysm without any obstruction or valvar deformity sometime after the second surgery. The present case suggests that the development of pericardial patch aneurysm may occur very late as shown previously. ...
A 26-year-old female patient who had surgical closure of the ventricular septal defect with an autologous pericardial patch and mitral valve repair for the cleft mitral valve in early childhood at age 4 and then subsequently mitral valve replacement with a bioprosthetic valve in 2011 at the age of 16 years, was found to have a large cystic mass protruding into the right ventricular inflow on echocardiography during a late routine examination in 2012. The cystic mass identified on echocardiography was shown to be an aneurysmal dilatation of the autologous pericardial patch used for the repair of the ventricular septal defect. As the third corrective surgery would have been inherently complicated with risk to the conduction system, she has been followed conservatively for the last 10 years without any significant complaints except mild dyspnea. This case illustrates that the pericardial patch aneurysm is relatively stable and surgery is rarely indicated unless the aneurysm causes mechanical compression or obstruction of the right ventricular inflow or outflow.
... In recent years, several studies have reported clinical outcomes of septal repair with autologous pericardium patch. In 2020 IJsselhof et al. reported that ventricular septal defects can safely be closed with either untreated autologous pericardium or xeno-pericardium, with no difference in left atrio-ventricular valve regurgitation or need for reoperation; the study was conducted on 77 paediatric patients (median age 3.6 months) and the median follow-up was 17.5 years (IJsselhof et al. 2020). A retrospective study on 156 patients with a median follow-up of 37 months have demonstrated that autologous pericardium treated with glutaraldehyde is as effective as Dacron mesh in ventricular septal defects repair, with no differences in clinical outcomes and reinterventions (Desai et al. 2022). ...
Pericardial patches are currently used as reconstructive material in cardiac surgery for surgical treatment of cardiac septal defects. Autologous pericardial patches, either treated with glutaraldehyde or not, can be used as an alternative to synthetic materials or xenograft in congenital septal defects repair. The availability of an allogenic decellularized pericardium could reduce complication during and after surgery and could be a valid alternative. Decellularization of allogenic tissues aims at reducing the immunogenic reaction that might trigger inflammation and tissue calcification over time. The ideal graft for congenital heart disease repair should be biocompatible, mechanically resistant, non-immunogenic, and should have the ability to growth with the patients. The aim of the present study is the evaluation of the efficacy of a new decellularization protocol of homologous pericardium, even after cryopreservation. The technique has proven to be suitable as a tissue bank procedure and highly successful in the removal of cells and nucleic acids content, but also in the preservation of collagen and biomechanical properties of the human pericardium.
Background
Some patients with pulmonary stenosis present with a complex multilevel disease that involves the valve, the leaflets, and the sinotubular junction (STJ) forming an hourglass appearance. We herein report the mid-term results of our experience with the reconstruction of the supravalvar narrowing using three pericardial patches.
Material and Methods
Retrospective analysis of patient charts and echocardiography studies of patients who underwent three-patch reconstruction of the pulmonary valve (PV) from 2013 to 2022. After PV transection distal to STJ, vertical incisions into the sinuses were performed, and leaflets were trimmed and thinned. The three sinuses were augmented using three pericardial patches.
Results
Nineteen patients underwent repair of hourglass supravalvar pulmonary stenosis. Mean weight at surgery was 9.4 kg (median 7.2, range 4.7-35); 16 patients underwent previous catheterization with unsuccessful balloon dilatation of the PV (13 pts.). Preoperative aortic/pulmonary annulus ratio was 1.02 (median 1, range 0.89-1.25). After surgery, gradients across the PV were significantly reduced (94 ± 26 vs 29 ± 9 mm Hg, P = .02). Postoperatively, 14 patients had mild or no pulmonary insufficiency (PI) and five had mild to moderate PI. At a mean follow-up of 71 months (median 78 months, range 8-137), gradients continued to decrease (29 ± 9 vs 15 ± 5 mm Hg, P < .001).
Conclusion
The three-patch technique for the repair of supravalvar pulmonary stenosis is simple, reproducible, and achieves excellent and long-standing relief of the right ventricular outflow tract gradient.
Over the last 20 years, a diverse number of different approaches have been explored in trying to produce engineered tissue vascular grafts (ETVGs). If successful, this alternative source of living vascular conduits with the ability to grow, remodel, and self-repair could revolutionize vascular surgery by relieving the limiting need for autologous grafts or providing substantial benefit and improved performance over their synthetic counterparts. However, despite tissue engineering being one of the hottest topics in biotechnology in the last three decades, it is generally acknowledged that the field's performance and its potential clinical translation have been somewhat disappointing. Pilot studies with ETVGs in animal models and preclinical human trials have been encouraging, but our understanding of the design requirements for ETVGs, how to effectively create them, and how to direct ETVG integration once implanted must be improved. This article reviews the current state-of-the-art of ETVGs with emphasis on the different manufacturing approaches explored in the past and challenges encountered and tackled, with particular focus on ETVGs that are very close to making a clinical impact and may potentially begin a new era of therapy for vascular disease.
