Abstract
Objective: To study early results of hand made fresh (autologous/homologous) pericardial valved conduit in achieving right ventricle to pulmonary artery continuity. Method: Between November 2014 and September 2015, 19 cases, with diagnosis of Tetralogy of Fallot with Pulmonary stenosis (PS) or Pulmonary atresia (PA) underwent intracardiac repair and Right Ventricular Outflow Tract (RVOT) reconstruction with hand made fresh [autologous (n = 2)/ homologous (n = 17)] pericardial valved conduit. Mean age of the patients at time of surgery was 6.37 years (range 3 months to 18 years), mean weight was 18.52 kilograms (range 6 kg to 40 kg) and mean size of the conduit was 20.7 mm (range 16 mm to 24 mm). Results: All patients had a smooth post-operative course, with mean ICU (Intensive Care Unit) stay of 3.6 days (range 3 days to 6 days) and mean post-operative hospital stay 8.5 days (range 7 days to 16 days). Intra-operative and Post-operative echocardiography revealed moderate Pulmonary regurgitation (PR) in one patient, mild PR in 5 patients and no or trace PR in 13 patients. No patient has developed conduit stenosis or calcification till now. Conclusion: Autologous or homologous pericardial valved conduit provides good early results and is especially suitable for developing world because of zero cost. Long term usefulness of such option remains to be confirmed in terms of dilation, calcification and freedom from intervention.
Highlights
Creating right ventricle to pulmonary artery continuity is essential in repair of many complex congenital heart diseases
Long term usefulness of such option remains to be confirmed in terms of dilation, calcification and freedom from intervention
Rastelli and colleagues [2] reported the use of a nonvalved pericardial conduit in the right ventricular outflow tract (RVOT) of a patient with tetralogy of Fallot (ToF) and pulmonary atresia with ventricular septal defect (VSD) and Ross and Somerville [3] reported the use of a homograft
Summary
Creating right (venous) ventricle to pulmonary artery continuity is essential in repair of many complex congenital heart diseases. A valved conduit always performs better than a non-valved conduit and helps in preserving the right ventricular function. An ideal valved conduit still remains the Holy Grail in cardiac surgery. It should comply with the following requisites: (1) some potential for its diameter to increase with time, (2) low likelihood of shrinkage or development of intimal peel or thrombus, (3) long-lasting valve function, (4) ready availability, and (5) low cost [1]. Rastelli and colleagues [2] reported the use of a nonvalved pericardial conduit in the right ventricular outflow tract (RVOT) of a patient with tetralogy of Fallot (ToF) and pulmonary atresia with ventricular septal defect (VSD) and Ross and Somerville [3] reported the use of a homograft. We created and modified later a tricuspid valved conduit instead of Schlichter’s bicuspid conduit by studying the normal pulmonary and aortic valve cusp diameters and cusp shapes [4] [5] [6]
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