Reconstruction of the pulmonary posterior wall using in situ autologous tissue for the treatment of pulmonary atresia wi
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RESEARCH ARTICLE
Open Access
Reconstruction of the pulmonary posterior wall using in situ autologous tissue for the treatment of pulmonary atresia with ventricular septal defect Chengming Fan, Yifeng Yang, Lian Xiong, Ni Yin, Qin Wu, Mi Tang and Jinfu Yang*
Abstract Background: To evaluate the early and mid-term results of pulmonary trunk reconstruction using a technique in which autogenous tissue is preserved in situ in pulmonary atresia patients with a ventricular septal defect (PA-VSD). Methods: The pulmonary artery was reconstructed using autogenous tissue that had been preserved in situ and a bovine jugular venous patch in 24 patients who were diagnosed with PA-VSD (the observation group). The traditional operation using a bovine jugular venous conduit was performed in 40 other cases of PA-VSD (the control group). Results: In the observation group, all patients survived and recovered successfully without complications. Follow-up echocardiography 2–10 years after the procedure showed that the reconstructed right ventricular outflow tract (RVOT) and pulmonary artery were patent, showing no evidence of flow obstruction. Only mild regurgitation of the bovine jugular vein valve was observed. In the control group, early postoperative death occurred in two cases. Another two patients had obstruction of the anastomotic stoma and underwent conduit replacement surgery within 2 weeks of the initial procedure. During the 2–10 years of follow-up care, six patients presented with valvular stenosis of the BJVC, with a pressure gradient of more than 50 mmHg. Conclusions: The technique for preserving autogenous tissue to reconstruct the pulmonary posterior wall is a satisfactory method for treating PA-VSD. Keywords: Congenital heart disease, Pulmonary atresia, Pulmonary reconstruction, In situ autogenous tissue
Background Pulmonary atresia with ventricular septal defect (PAVSD) is a rare and complex cyanotic congenital heart malformation that has a high incidence of early mortality. Although surgical interventions have been employed successfully for a number of years, the long-term prognosis has remained poor with an increased incidence of sudden death [1]. In 1955, Lillehei et al. successfully corrected an atresia of the main pulmonary artery (MPA) and a ventricular defect in a patient who had been diagnosed with PA-VSD by anastomosing the distal pulmonary artery with the right ventricle [2]. A decade * Correspondence: [email protected] Department of the cardiovascular surgery, the Second Xiangya Hospital, Central South University, Middle Renmin Road 139, 410011 Changsha, China
later, Rastelli and colleagues reported a case in which a cardiac conduit from the right ventricle to the pulmonary trunk was used to treat the abnormality [3]. Various extracardiac valved conduits have subsequently been used to correct a right ventricle to pulmonary artery discontinuity since Ross and Somerville successfully employed a homograft aortic valved conduit in 1966 [4]. Weldon et al. reported the same result 2 years later [5]. In 197
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