[Reconstruction of pulmonary trunk in pulmonary atresia and tetralogy of Fallot utilizing autologous tissue].
Establishment of right ventricular-pulmonary arterial continuity with autologous tissue, avoiding the use of prosthetic conduit, is presented. From February 1992 through March 1993, 22 patients with pulmonary atresia and tetralogy of Fallot underwent reparative operation at The Heart institute of Japan. In 20 patients out of the 22 patients, the right ventricular-pulmonary arterial continuity was successfully established with either direct anastomosis or insertion of tailored autologous pericardial tube. The morphology of the right ventricular-pulmonary arterial discontinuity comprised of valvular and infundibular atresia in seven, truncal atresia in nine, and failed extracardiac conduit in four. In patients with relatively short distance between right ventricle and pulmonary artery, the pulmonary artery was retracted and anastomosed directly to the cranial margin of the ventriculotomy incision to serve as a smooth floor made of autologous tissue. In patients with long distance, tailored autologous pericardial tube was interposed between right ventricle and pulmonary artery instead of using prosthetic conduit. Both techniques were completed by mono- or bicuspid anterior patch made of equine pericardial conduit. There were no early and late deaths. Postoperative catheterization data showed satisfactory reduction of right ventricular pressure with the right-to-left ventricular systolic pressure ratio ranging from 0.42 to 0.69 (average 0.52) in direct anastomosis group and 0.43 to 0.48 (average 0.45) in autologous pericardial tube group, and the pressure gradient across right ventricular outflow tract ranged from 1 to 15 (average 8) mmHg and 1 to 15 (average 5.8), respectively. The distributing frequency of late complication, mainly conduit obstruction, of prosthetic materials prompted us to use autologous tissue.(ABSTRACT TRUNCATED AT 250 WORDS)
Ando
M
M
Division of Pediatric Cardiac Surgery, Heart Institute of Japan.
Imai
Y
Y
Hoshino
S
S
Ishihara
K
K
Tezuka
M
M
Seo
K
K
Misumi
H
H
Terada
M
M
Isomatsu
Y
Y
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006801:Humans; D011651:Pulmonary Artery / Q000601:surgery*; D018633:Pulmonary Atresia / Q000601:surgery*; D013771:Tetralogy of Fallot / Q000601:surgery*; D014182:Transplantation, Autologous