title: Critical role of the sinuses of Valsalva in the durability of valved conduits.
abstract: OBJECTIVE
  Most work in search of an ideal extracardiac valved conduit has assumed that the type of tissue used for construction is the determining factor for its behavior and durability. The excellent results of our study with a valved conduit incorporating sinuses of Valsalva and made of autologous pericardium showed that the design plays a crucial role in addition to the type of material.
  
  
  METHODS
  We report the experimental results of three different pericardial sinus bearing valved conduits made of 0.5% glutaraldehyde treated autologous pericardium (Group 1), dye mediated photooxidized bovine pericardium (Group 2), and glutaraldehyde treated bovine pericardium (Group 3) implanted in the right ventricular outflow tract of sheep. Groups 1, 2 and 3 had 11, 11 and four animals available for assessment out of 12, 18 and six implantations respectively. The valved conduits were explanted at varying intervals between one and 11 months. The conduit function was assessed with hemodynamic, echocardiographic and Doppler studies both at the time of implantation and sacrifice. The explanted conduit was studied macroscopically and subjected to histopathologic examination.
  
  
  RESULTS
  The hemodynamic and echocardiographic studies at implantation showed very satisfactory results in all three groups. At the time of sacrifice, Group 1 showed consistently good results. In a significant number of animals in Groups 2 and 3, one, two or even three cusps had become adherent to the conduit wall, resulting in severe regurgitation. The sinuses were well preserved in Group 1, while they were less prominent in Group 2 and least in Group 3. Histopathologically, the three groups basically showed the same feature, a process of fibrocellular proliferation resulting in thickening. In this study the adhesion of the cusps to the sinus wall was related to the degree of prominence of the sinuses of Valsalva, which in turn depended on the ability to shape the pericardium at the time of construction of the valved conduit.
  
  
  CONCLUSIONS
  This study stresses the importance of the sinuses in the behavior of the semilunar valve leaflets.
authors.affiliation: Department of Cardiovascular Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: S P
authors.initials: SP
authors.lastname: Kumar
authors.forename: M N
authors.initials: MN
authors.lastname: Kumar
authors.forename: M L
authors.initials: ML
authors.lastname: Ali
authors.forename: A
authors.initials: A
authors.lastname: Becker
authors.forename: C M
authors.initials: CM
authors.lastname: Duran
mesh_terms: D000818:Animals; D001705:Bioprosthesis; D002417:Cattle; D004452:Echocardiography; D006350:Heart Valve Prosthesis; D006439:Hemodynamics; D010496:Pericardium / Q000637:transplantation*; D011474:Prosthesis Design; D012756:Sheep; D012850:Sinus of Valsalva; D014021:Tissue Preservation