Palliative reconstruction of right ventricular outflow tract by using femoral vein allograft in a newborn with hypoplastic pulmonary artery and ventricular septal defect: case report

Treating patients with pulmonary atresia and ventricular septal defect, who have hypoplastic native pulmonary arteries, is a challenge for cardiac surgeons. We have reported a case of successful pulmonary bed rehabilitation using a femoral vein allograft in a patient with pulmonary atresia and ventricular septal defect. No similar cases with a detailed description of surgery stages and pulmonary artery development supported by illustrative materials are described both in the literature. The strategy of rehabilitation of the native pulmonary artery bed facilitates antegrade pulmonary blood flow, increases native pulmonary arteries growth, contributes to successful implementation of staged endovascular interventions and allows for complete repair. The technique of “short” cardiopulmonary bypass with induced ventricular fibrillation is a safe and effective option for such patients. This clinical case might be useful in medical practice of pediatric cardiac surgeons involved in the problem of pulmonary artery rehabilitation.Received 4 June 2018. Revised 4 July 2018. Accepted 5 July 2018.Informed consent: The legal representative (infant’s mother) has voluntarily given her written informed consent to use the infant’s medical data obtained in the course of treatment for scientific purposes and for their publication.Funding: The study had no sponsorship.Conflict of interest: Authors declare no conflict of interest.</p

Epoxy- versus Glutaraldehyde-Treated Bovine Jugular Vein Conduit for Pulmonary Valve Replacement: A Comparison of Morphological Changes in a Pig Model

Valved conduits are often required to replace pulmonary arteries (PA). A widely used Contegra device is made of bovine jugular vein (BJV), preserved with glutaraldehyde (GA) and iso-propanol. However, it has several drawbacks that may be attributed to its chemical treatment. We hypothesized that the use of an alternative preservation compound may significantly improve BJV conduit performance. This study aimed to compare the macroscopic and microscopic properties of the BJV treated with diepoxide (DE) and GA in a porcine model. Twelve DE-BJVs and four Contegra conduits were used for PA replacement in minipigs. To assess the isolated influence of GA, we included an additional control group—BJV treated with 0.625% GA (n = 4). The animals were withdrawn after 6 months of follow-up and the conduits were examined. Explanted DE-BJV had a soft elastic wall with no signs of thrombosis or calcification and good conduit integration, including myofibroblast germination, an ingrowth of soft connective tissue formations and remarkable neoangiogenesis. The inner surface of DE-BJVs was covered by a thin neointimal layer with a solid endothelium. Contegra grafts had a stiffer wall with thrombosis on the leaflets. Calcified foci, chondroid metaplasia, and hyalinosis were observed within the wall. The distal anastomotic sites had hyperplastic neointima, partially covered with the endothelium. The wall of GA-BJV was stiff and rigid with degenerative changes, a substantial amount of calcium deposits and dense fibrotic formations in adventitia. An irregular neointimal layer was presented in the anastomotic sites without endothelial cover in the GA BJV wall. These results demonstrate that DE treatment improves conduit integration and the endothelialization of the inner surface while preventing the mineralization of the BJV, which may reduce the risk of early conduit dysfunction