Autologous pericardium for ventricular septal defect closure.
OBJECTIVE
The use of living, untreated autologous pericardium for patch repair in the left ventricular outflow tract was considered attractive in children.


METHODS
Ventricular septal defect (VSD) closure with an untreated autologous pericardial patch was performed in 102 children of mean age 13.4 months (range: 1 to 73 months). Postoperative transthoracic Doppler echocardiography was performed in all children at a mean of nine weeks (range: one day to 50 weeks) after surgery. One pericardial patch, which was explanted at autopsy two months after surgery, was studied microscopically.


RESULTS
At short-term follow up, no or only minor residual VSD was found in 97 patients, moderate VSD in two and severe VSD in one patient. One patient was reoperated for residual VSD and an aneurysmic patch first diagnosed seven days after surgery. Two more patients showed ballooning of the patch without VSD after five and seven days respectively. All aneurysmic patches were attributed to intraoperative patch oversizing. Patch integrity was confirmed in all other patients. No inflammatory or degenerative changes were observed at microscopy, rather a remodeling response had caused the patch to thicken, indicating an adaptation of the living tissue.


CONCLUSIONS
The untreated autologous pericardial patch has shown to be a safe alternative for VSD closure, provided that the patch is properly sized.
Department of Cardiothoracic Surgery, University Hospital, Leiden, The Netherlands.
P H
PH
Schoof
M G
MG
Hazekamp
K
K
van Ulzen
M M
MM
Bartelings
J A
JA
Bruyn
W
W
Helbing
H A
HA
Huysmans
D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D010496:Pericardium / Q000637:transplantation*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D013997:Time Factors; D014182:Transplantation, Autologous