Living, Autologous Pericardial Monocusp Patch In Reconstruction Of The Right Ventricular Outflow Tract

Objective To conclude the results of reconstruction of right ventricular outflow tract (RVOT) using autologous pericardial monocusp patch treated with distilled water, and compare its effects with no-valve pericardial patch treated with glutaraldehyde.Methods The clinical material of 89 continuous patients, which underwent reconstruction of RVOT, were analyzed retrospectively. These patients were divided into two groups according to their operating time. Group A: 50 continuous patients with congenital heart disease underwent reconstruction of RVOT between Jun 2003 and May 2006, and the operations were performed with autologous pericardial monocusp patch treated by distilled water; Group B: between Jun 2000 and May 2003, another 39 continuous patients underwent reconstruction of RVOT with no-valve pericardial patch treated with glutaraldehyde. The patients of both groups were diagnosed as congenital heart disease with obstruction of RVOT by UCG and/or DSA. The age, cross-clamp time, CPB time, preoperative and postoperative maximum velocity of flow above pulmonary valve(Vmax/Vmax'), ventilation time, degree of postoperative pulmonary regurgitation of two groups were compared.Results There is no in-hospital death in monocusp group, and all 39 patients dismissed from hospital all right. No obvious right heart failure was found in the patients, which were followed up from 1 to 36 months. In no-valve group, one patient with tetralogy of Fallot and lack of right pulmonary artery died of respiratory failure at day three postoperatively; another four patients had repeatedly postoperative right heart failure after leaving hospital. The patients with moderate-severe postoperative pulmonary insufficiency in no-valve group are more than monocusp group statistically.Conclusions Reconstruction of RVOT using autologous pericardial monocusp patch treated by distilled water in patients with obstruction of RVOT is beneficial to lower the postoperative pulmonary insufficiency, and enhance the heart function. Compared to the patch dealt with glutaraldehyde, the autologous pericardial patch treated by distilled water is living, and calcification is not easily to happen. At the same time, after treated by distilled water, pericardial patch is incrassated mildly, and can be handled easier than fresh pericardium. The early-moderate team results of reconstruction of RVOT using autologous pericardial monocusp patch treated by distilled water are satisfactory.