Expanded polytetrafluoroethylene valved conduit and patch with bulging sinuses in right ventricular outflow tract reconstruction.
OBJECTIVE
No specific prosthetic material is currently recognized as being the most suitable for right ventricular outflow tract reconstruction for congenital heart defects. Prosthetic valves are subject to wear and stress because they do not create vortex flow, which helps natural valves to close. We designed a fan-shaped expanded polytetrafluoroethylene valved conduit and patch with bulging sinuses that create vortex flow, making them more reliable over the long term.


METHODS
Bulging sinuses were formed on a sheet of expanded polytetrafluoroethylene using a specially designed mold. Fan-shaped expanded polytetrafluoroethylene sheets (0.1 mm thick) were anastomosed to the edge of the bulging sinuses as valve leaflets, creating monocuspid, bicuspid, or tricuspid valves. These valves were implanted in 157 patients undergoing right ventricular outflow tract reconstruction (age 16 days to 45.4 years, median 2.0 years), in 48 patients as a conduit, and in 109 patients as a patch. Valve function was followed up by echocardiography for 5.6 to 63.7 months (mean 20.8 months).


RESULTS
There was no mortality or morbidity, and no patients required reoperation during follow-up. No patients had stenosis, and regurgitation was less than mild in all patients with conduits and moderate in 15 patients (13.8%) with patches, but moderate regurgitation did not further develop during follow-up. Valve motion was fully maintained in all patients.


CONCLUSIONS
The expanded polytetrafluoroethylene valved conduits and patches with bulging sinuses showed excellent early-to-midterm results. The valved conduits and patches seem to be promising alternatives to homografts in right ventricular outflow tract reconstruction. Their function will be followed up further.
Department of Pediatric Cardiovascular Surgery, Children's Research Hospital, Kyoto Prefectural University of Medicine, Hirokoji, Kamigyo-ku, Kyoto, Japan.
Takako
T
Miyazaki
Masaaki
M
Yamagishi
Atsuhiro
A
Nakashima
Kouji
K
Fukae
Toshihide
T
Nakano
Hitoshi
H
Yaku
Hideaki
H
Kado
D000293:Adolescent; D000328:Adult; D001807:Blood Vessel Prosthesis; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000601:surgery*; D014694:Ventricular Outflow Obstruction / Q000601:surgery*
D011138:Polytetrafluoroethylene