Patch Reconstruction Research Articles

Transcatheter pulmonary valve implantation in native pulmonary outflow tract using the Edwards SAPIEN™ transcatheter heart valve

Percutaneous pulmonary valve implantation (PPVI) is now an accepted alternative option to conventional surgery for patients with dysfunctional conduits between the right ventricle and pulmonary artery. PPVI will reduce the total number of repeat operations in such patients. However, surgery remains the primary option in postoperative tetralogy of Fallot patients with severe pulmonary regurgitation who underwent transannular patch reconstruction of their right ventricular outflow tract (RVOT). Traditionally, an RVOT patch is considered a relative contraindication to PPVI, however, in selected patients PPVI was successfully performed. We report the case of a 12-year-old patient after neonatal repair of tetralogy of Fallot and pulmonary atresia, who developed advanced liver disease and severe pulmonary regurgitation. In this patient, the risk for surgical valve replacement was considered too high and he was treated with percutaneous implantation of the Edwards SAPIEN™ transcatheter heart valve.

Pulmonary Atresia, Ventricular Septal Defect, and Major Aortopulmonary Collaterals: Neonatal Pulmonary Artery Rehabilitation Without Unifocalization

This study analyzed a protocol of neonatal rehabilitation of hypoplastic pulmonary arteries in the management of pulmonary atresia, ventricular septal defect (VSD), and major aortopulmonary collateral arteries (MAPCAs). Ideal management of patients with pulmonary atresia, VSD, and MAPCAs is the subject of controversy. From June 2003 to December 2008, 25 consecutive patients were diagnosed with pulmonary atresia, VSD, and MAPCAs, and 20 were entered into a neonatal shunting regimen. The median age at the first operation was 3.6 weeks (range, 0.7 to 17 weeks). All patients underwent an initial central or modified Blalock-Taussig shunt, or both. Further preparatory procedures included 26 pulmonary artery patch reconstructions, 19 right ventricle-to-pulmonary artery conduits, 4 MAPCA ligations, and 4 further shunts. No patient underwent translocation of the collateral arteries. At the latest follow-up, 12 of 20 patients have had a complete repair at a median age of 18 months (range, 11 to 48 months), 6 are awaiting repair, and 2 are considered unlikely to be repaired. No patient was missing follow-up. Median pulmonary artery indices had grown from 14.51 to 118.7 in 17 patients. Postoperative angiograms were performed at a median of 8 months (range, 1.9 to 32.7 months) in 9 of 12 completely repaired patients. The median right/left ventricular pressure ratio was 0.64 (range, 0.54 to 0.91). Rehabilitation of hypoplastic native pulmonary arteries by a neonatal shunting regimen, without MAPCA translocation, for pulmonary atresia, VSD, and MAPCAs, provides encouraging results with excellent early survival.

Long-Term Outcome of Direct Neopulmonary Artery Reconstruction During the Arterial Switch Procedure

Neopulmonary stenosis at anastomosis site is one of the most frequent complications after the arterial switch procedure for transposition of the great arteries. The surgical technique is a crucial factor associated with the frequency of stenotic complications. We present the outcomes of direct neopulmonary anastomosis during the arterial switch procedure in patients with simple transposition. This research was to assess the efficacy of this surgical technique based on the incidence of postprocedural supravalvular neopulmonary stenosis (SVPS). Among 545 patients operated on in our department between 1992 and 2009, the 346 consecutive survivors who had undergone simple transposition in the first month of life were included in this analysis. Switch procedures were performed with direct neopulmonary artery anastomosis in 318 patients (92%); in the remaining 28 (8%), the risk of coronary artery compression required the use of a pericardial patch for pulmonary reconstruction. Neopulmonary stenosis occurred in 9 patients (2.6%): 5 had undergone direct neopulmonary reconstruction, and 4 had been treated with a patch. Balloon angioplasty of SVPS was performed twice in 1 patient. No patients required reoperation to treat neopulmonary stenosis. In multivariate analysis (logistic regression), patch reconstruction (odds ratio, 27.5; p=0.001) and nonfacing commissures (odds ratio, 11.1; p=0.004) were correlated significantly with the incidence of SVPS. Direct neopulmonary artery anastomosis during arterial switch is an interesting alternative to patch reconstructions and ensures a good postoperative result with low rates of complications and SVPS.

Echokardiographische und klinische Evaluation nach Mitralklappenchirurgie bei schwer verkalktem Mitralklappenanulus im Langzeitverlauf

The aim of this study is the analysis of long-term results in patients with hemodynamically significant mitral valve disease due to extensive calcified mitral annulus who underwent decalcification and patch reconstruction. Between 1996 and 2008 a total of 109patients underwent surgery in the presence of extensive calcification, severe mitral insufficiency and mitral stenosis. The mean age of patients (65women, 44men) was 66.4±13.8years. Mitral valve repair was performed in 53patients (49%), while the remaining 56patients (51%) received a mitral valve replacement. In all, 64patients (59%) required concomitant surgery. The mean follow-up time was 96±48months. Inpatient and late mortality rates were 8.3% (nine patients) and 25.6% (28patients), respectively. The actuarial survival rates at 5, 8 and 12years were 88.1%, 76.2% and 66.1%. Echocardiographic follow-up demonstrated mitral insufficiencyIII in four patients (6%). No patients had mitral insufficiencyIV. We observed a significant reduction in left atrium diameter, LVEDD as well as mean transvalvular gradient. Freedom from reoperation at 5 and 8years was 96.4% and 91.8%, respectively. We found systemic hypertension, diabetes mellitus, age above 65years, concomitant aortic valve replacement, concomitant procedures, chronic renal insufficiency and cardiac decompensation in the medical history as predictors for significantly increased early or late mortality. The long-term results strongly suggest that en bloc decalcification and patch reconstruction of the mitral annulus can be safely undertaken in high-risk patients.

Abstract P56: Early and Mid-Term Outcome of LAD Endarterectomy and Left Internal Mammary Artery Bypass in Patients with Severe Coronary Artery Disease with Poor Targets

Background: With the advancement of percutaneous trans-coronary angioplasty and stenting, patients referred for bypass grafting (CABG) are usually higher-risk and have advanced coronary artery diseases (CAD). The distal targets are frequently diffusely calcified and not amenable for stenting or even CABG. The objective of this study is to review the outcome of endarterectomy in the LAD, in addition to conventional left internal mammary artery (LIMA). Methods: Between September 2005 to June 2010, 52 consecutive patients operated on for severe multi-vessel CAD affecting the LAD were managed with endarterectomy, with or without patch (vein or LIMA) reconstruction, in addition to LIMA grafting of the LAD (Group E). Their medical records were reviewed retrospectively and patients followed prospectively. Another 52 matched-control patients operated on with conventional CABG (Group C) over the same period were used to compare their clinical outcome. CT angiography was performed in 24 Group E patients between 3-23 months post-operatively. Continuous variables were expressed as mean±SD and categorical variables were expressed as absolute numbers. All variables were analyzed with univariate and multi-variate analysis to determine whether any single factor influenced outcome. P<0.05 is considered significant. Results: The demographic characteristics, operative data between groups were recorded. All patients remain free of angina or symptoms of congestive heart failure with zero 30-days mortality. Compared with control, post-operative inotropic/pressor requirements were significantly lower (p= 0.001), despite longer surgery time (p<0.0001) in group E. CT-angio showed LIMA graft patency in all studied Group E patients. Although the median ICU stay was significantly longer in endarterectomy patients (p<0.0001), the overall hospital stay was similar between groups (p=0.76). Conclusions: In patients with diffused LAD disease, the use of extensive endarterectomy with or without patch reconstruction followed by LIMA graft offers a safe alternative for complete revascularization. Alternative techniques with excellent early results can be considered in poor coronary distal beds before rendering the patients non-operable.

Transverse Aortic Arch to Descending Aorta Ratio: A New Echocardiographic Parameter for Management of Coarctation of the Aorta in the Infant

The purpose of this study was to establish an objective criterion to help assess adequacy of the transverse arch in newborns with coarctation and thereby optimize preoperative surgical decision making. Echocardiograms of 47 patients < 6 months of age who underwent coarctation repair from September 2005 to November 2008 and 47 age-matched healthy infants were reviewed. The proximal and distal transverse aortic arch to descending aorta ratios (TAA:DAO ratio) were calculated from the end-systolic proximal and distal transverse aortic arch diameters and diameter of the descending aorta at the diaphragm. Both the proximal and distal TAA:DAO ratios were significantly lower in the study vs. control group (P = .001) and in patients who underwent patch reconstruction of the aorta vs. extended end-to-end anastomosis (P = .014; P = .015). All patients who underwent patch reconstruction had a proximal and/or distal TAA:DAO < 0.65. A cutoff of 0.65 was derived based on our analyses and an algorithm was developed to guide decision making. Forty-six out of 47 patients were free from reintervention. The TAA:DAO ratio appears to be an accurate parameter by which the adequacy of the transverse arch can be assessed preoperatively using the proposed algorithm, and thus help determine the type of surgical intervention and approach.

Large diaphragmatic defect: are skeletal deformities preventable?

The aim of study was to compare growth, nutritional status and incidence of chest wall deformities and scoliosis in survivors of large congenital diaphragmatic hernia (CDH) defect (Gore-Tex patch reconstruction) with survivors with smaller defects and primary reconstruction. An anthropometric study of 53 children who underwent CDH repair in neonatal period was carried out. Weight, height, and skin-fold thickness were measured, scoliosis and chest wall deformity were evaluated. Body mass index (BMI) and thoracic index (TI) were calculated using standard rules. The measured data were compared with national population standard with the use of standard deviation score (SDS). According to the type of diaphragmatic reconstruction, the patients were divided into two groups [Gore-Tex patch (10) versus primary repair (43)]. Student t test and Fisher exact tests were used for statistical analysis. Pectus excavatum was found in 25 (47%) patients, poor posture in 33% and significant scoliosis in 5%. Compared with the population norm, CDH children had a significantly lower body height SDS (mean -0.39, p<0.05), weight SDS (mean -0.75, p<0.001), BMI (mean SDS -0.68, p<0.001) and lower TI (mean SDS -0.62, p<0.01). Gore-Tex versus primary repair group significantly differed in incidence of pectus excavatum and BMI (PE: p=0.027, BMI SDS: p=0.016). A majority of anthropometric parameters (weight, height, thoracic index, and thorax circumference) and incidence of scoliosis and poor posture in children after Gore-Tex patch reconstruction did not significantly differ from children after primary repair. The differences in some anthropometric parameters (weight, BMI, and TI) and in the skeletal deformity suggest that the CDH not only disturbs normal lung growth, but also seems to have implications on some other aspects of somatic development. Whether these changes could be related to the type of diaphragmatic reconstruction or rather to the size of the defect remains uncertain.

Exposure Fusion for Time‐Of‐Flight Imaging

AbstractThis work deals with the problem of automatically choosing the correct exposure (or integration) time for time‐of‐flight depth image capturing. We apply methods known from high dynamic range imaging to combine depth images taken with differing integration times in order to produce high quality depth maps. We evaluate the quality of these depth maps by comparing the performance in reconstruction of planar textured patches and in the 3D reconstruction of an indoor scene. Our solution is fast enough to capture the images at interactive frame rates and also flexible to deal with any amount of exposures.

Patch Reconstruction with T-Splines Iterated Fitting for Mesh Surface

A coupling method of surface patch reconstruction based on T-splines is presented. The iteration T-splines reconstruction method is employed in general patching, and the iterative T-NURCCs is employed at singular points. Despite the differences of optimization strategies, they are all represented in T-splines, whose data structures and evaluation procedures are identical. The method is adapted to reconstruct complex models.

Inferior Vena Cava Resection and Reconstruction for Retroperitoneal Tumor Excision

The purpose of this study was to review the results of resection and reconstruction of the inferior vena cava (IVC) for en bloc malignant tumor excision. We conducted a retrospective review of all patients having IVC resection for en bloc malignant tumor excision. IVC resection was categorized as suprarenal, perirenal, infrarenal, or extensive (>1 segment resected). Repairs were divided into primary, patch, or circumferential. Tumor type, perioperative morbidity, mortality, clinical graft patency, and survival (social security death index) were recorded. Between 1992 and 2010, 48 patients (24 female) had IVC resection for tumor en bloc excision. Sarcomas were most common (33; 69%: 5 [10%] primary IVC). Thirteen patients had primary IVC repair, nine patch repairs (one autogenous), and 26 had circumferential replacement with polytetrafluoroethylene (PTFE) ringed graft (12-16 mm). Extensive IVC reconstructions were performed in 17 cases of which seven involved the entire IVC with renal vein (RV) and hepatic vein reimplantation, six were suprarenal and perirenal (seven RV reimplanted), and four were infrarenal and perirenal (four RV reimplanted). All single segment (9) repairs were infrarenal. Overall morbidity was 6% (one bowel obstruction requiring surgery, one chyle leak resolved with medical therapy, and one renal failure with complete recovery [L RV reimplant, R nephrectomy]). There was no difference in morbidity between primary, patch, circumferential, and extensive reconstruction. There was no mortality. One IVC graft thrombosis was documented on follow-up (after chemotherapy/sepsis). There were two graft stenosis associated with tumor recurrence. Lower extremity edema was universally avoided. Mean long-term survival was 3.34 years (4 months to 11 years) with a significant difference between primary or patch (mean 66.7 months) and circumferential or extensive repair (mean 39.7 months; P < .005). There was no survival difference between single segment and extensive IVC repair (36.7 vs 42.8 months; P > .12). IVC resection and reconstruction for en bloc tumor excision is safe even when extensive repairs are necessary. Replacement of the IVC with a prosthetic graft avoids extremity venous complications and likely contributes to quality of survival. Survival is dependent on tumor behavior and degree of IVC involvement where primary and patch repair has a better prognosis than circumferential resection.

Factors affecting survival after lobectomy with pulmonary artery resection for primary lung cancer

Prognostic factors in patients who underwent pulmonary angioplasty remain controversial. Here, we report a case-series study of this surgical procedure based on our 20-year single-center experience. Medical records of patients, who underwent a major lung cancer operation with pulmonary artery resection, were reviewed retrospectively. From 1986 to 2006, 61 (3%) of 2296 patients required pulmonary artery resection to avoid pneumonectomy for lung cancer surgery. We performed 34 circumferential resections and 27 wedge resections accompanied by lobectomy or bilobectomy, and all repairs were performed with end-to-end anastomoses or direct suturing. Patch reconstruction, synthetic/biological prosthesis, and pericardial conduit were not used. Forty-nine patients (80%) underwent concomitant carinoplasty (n = 2) or bronchoplasty (n = 47). After surgery, two patients died (mortality 3.3%) and major complications were noted in 14 patients (morbidity 23.0%). Although seven patients had local recurrences (four intrathoracic and three lymph nodes), no recurrence was observed along the pulmonary artery suture line. With a mean follow-up period of 46.0 ± 40.5 months, overall and disease-free survival rates for all cases were 47.0% and 40.0% at 5 years, and 40.2% and 33.6% at 10 years. According to the nodal status, the 5-years' overall and disease-free survivals were 76.0% and 62.9% for pN0 cases (n = 14), 45.7% and 43.5% for pN1 cases (n = 27), and 28.9% and 20.0% for pN2 + pN3 cases (n = 20), respectively (p = 0.014 and 0.036). Multivariate analysis indicated that nodal status was the only prognostic factor on both overall and disease-free survival. A major anatomical lung operation with pulmonary artery resection is feasible for selected patients with primary lung cancer. Long-term outcomes are significantly influenced by nodal status and are comparable to those of conventional lobectomy. Most operative complications are controllable with acceptable mortality and morbidity rates. The anastomosed site was not placed at risk for local recurrence. These data support pulmonary angioplasty as a valuable option in the treatment of lung cancer.

3D Building Model Reconstruction from Multi-view Aerial Imagery and Lidar Data

A novel approach by integrating multi-view aerial imagery and lidar data is proposed to reconstruct 3D building models with accurate geometric position and fine details. First, a new algorithm is introduced for determination of principal orientations of a building, thus benefiting to improve the correctness and robustness of boundary segment extraction in aerial imagery. A new dynamic selection strategy based on lidar point density analysis and K-means clustering is then proposed to identify boundary segments from non-boundary segments. Second, 3D boundary segments are determined by incorporating lidar data and the 2D segments extracted from multi-view imagery. Finally, a new strategy for 3D building model reconstruction including automatic recovery of lost boundaries and robust reconstruction of rooftop patches is introduced. The experimental results indicate that the proposed approach can provide high quality 3D models with high-correctness, high-completeness, and good geometric accuracy.

Huge pseudo-aneurysm of right ventricular outflow tract after patch reconstruction in tetralogy of Fallot

Huge pseudo-aneurysm of right ventricular outflow tract after patch reconstruction in tetralogy of Fallot

Hybrid Procedure for Obstructive Neonatal Left Ventricular Tumors

We report the use of the hybrid procedure (bilateral pulmonary artery banding, ductal stenting followed by balloon atrial septostomy) in the first week of life for the treatment of two neonates with large left ventricular fibromas resulting in univentricular physiology. At 6 months of age, second-stage palliation was accomplished and the 2 patients are growing well with normal developmental milestones and no atrial or ventricular ectopy at 30 months. Hybrid strategy offers a less invasive, initial intervention and the options of typical second-stage univentricular palliation, conversion to biventricular physiology in cases of tumor regression, planned surgical resection, or transplantation.

Endovascular Treatment of an Infected Carotid Prosthetic Patch and Pseudo-aneurysm

Prosthetic patch infection following carotid endarterectomy (CEA) is rare and usually requires surgical excision of the patch and carotid ligation or reconstruction. We present a case of carotid patch infection with pseudoaneurysms successfully treated with a covered stent. Follow-up to 31 months demonstrated no clinical, biochemical or microbiological evidence of local or systemic infection and surveillance duplex confirmed continued exclusion of the pseudoaneurysm. At fourteen months, symptomatic proximal and distal restenoses were successfully restented. The patient then remained asymptomatic, but the distal stenosis recurred. Endovascular treatment may be an alternative to surgery, particularly in those who are high risk.

Surface Patch Reconstruction From “One-Dimensional” Tactile Data

This paper studies the reconstruction of unknown curved surfaces through finger tracking. A patch can be generated from tactile data points along three concurrent surface curves under the Darboux frame estimated at the curve intersection point. Surface fitting while minimizing the total (absolute) Gaussian curvature effectively prevents unnecessary folds otherwise expected to result from the use of such "1-D" data. The implementation involves a two-axis joystick sensor, a three-fingered 4-DOF BarrettHand, and a 4-DOF Adept SCARA robot. Experiments have demonstrated good accuracy of reconstruction.

Right Ventricular Outflow Tract Patch Reconstruction in Anomalous Origin of Right Coronary Artery

A new technique to repair tetralogy of Fallot or double-outlet right ventricle with an anomalous right coronary artery arising from the left anterior descending coronary artery and crossing the right ventricular outflow tract is described. The right coronary artery was mobilized, transected, and re-implanted into the ascending aorta. The right ventricular outflow tract and ventricle septal defect were repaired through a ventriculotomy and pulmonary arteriotomy. The right ventricular outflow tract and pulmonary annulus were reconstructed with a pericardial patch. Five consecutive patients underwent this technique between August 2007 and October 2008. The indications of the electrocardiograms were no heart ischemia in all patients at mean follow-ups conducted at 5 to 19 months. All the patients were in New York Heart Association functional class I at the time of last follow-up.

Bailout stenting for critical coarctation in premature/critical/complex/early recoarcted neonates

Surgical repair of critical coarctation can be problematic in premature, critical, complex, or early postoperative neonates. We aimed to review our experience with stent implantation to defer urgent surgery to an elective time. Fifteen neonates with severe aortic coarctation: five premature-hypotrophic (1,400-2,000 g), six critical and complex cardiac malformation, four early (1 day [0-2 days]; median [range]) after surgical coarctectomy or complex arch reconstruction. Bare coronary stents (diameter 4.0 [3.5-5.0] mm; length 10 [8-16] mm) were used. Stents were removed surgically depending on clinical needs. Adequate aortic flow was obtained in 15 patients. The femoral artery was preserved in 13/15 patients. Two deaths occurred before stent removal and were nonprocedure related. In patients with simple stented coarctation, the stent was removed after 2.8 [0.2-5.0] months. In complex cardiac malformation, stents were finally removed 3.0 [0.2-78] months after implantation. simple coarctectomy end-to-end in eight, extensive arch patch reconstruction in four. One patient is awaiting stent removal. The final maximum systolic velocity (cw-Doppler) across the aortic arch was 1.7 [1.2-2.5] m/sec. In premature/critical/complex neonates with severe coarctation, bailout stenting followed by early or late surgical coarctectomy appears a promising concept.

Extracranial Internal Carotid Artery Mycotic Aneurysm: A Case Report

Mycotic aneurysms of the extracranial carotid arteries (MCAs) are extremely rare. They usually appear as an enlarging pulsatile neck mass with no specific signs and symptoms, and they can lead to severe morbidity and mortality if left untreated. We report a case of a saccular thrombosed MCA in a 68-year-old man, presented as a non-pulsatile enlarging mass. The patient did not have any clinical signs of infection, and he was treated with resection of the MCA and synthetic patch reconstruction of the carotid bifurcation. Postoperative microbial cultures revealed Streptococcus parasanguinis. We review and discuss the literature regarding the clinical presentation, diagnosis and treatment options of MCAs.

Cardiac computed tomography in the evaluation of left anterior descending coronary artery with vein patch reconstruction

This study evaluated the morphological and functional results of surgical reconstruction of the left anterior descending (LAD) coronary artery with an autologous vein patch, associated with left internal mammary artery (LIMA) grafting onto the patch. Cardiac computed tomography (CT) images were assessed in terms of functional and morphological parameters. Function was evaluated by assessing patency at 36 months of the reconstructed LAD (based on the attenuation of the native vessel distal to the anastomosis). Morphology was evaluated by studying vein-patch diameters, profiles and margins, shape and structure to categorise the patches into three groups (A, B, C). Within 1 month of CT, all patients underwent functional testing (bicycle ergometry). CT imaging correctly depicted the LAD graft, revealing it to be fully patent in all cases. On the basis of our morphological classification, 21 patients were classed as group A, two as group B and two as group C. At bicycle ergometry, 23 patients were negative and two were positive. Group C patients had the worst functional results. Cardiac CT allowed adequate evaluation of the LAD graft patency and morphology, and in consideration of its noninvasive nature, it may become the imaging tool of choice for evaluating extended LAD reconstruction.