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J Thorac Cardiovasc Surg 2000;120:66-72
© 2000 The American Association for Thoracic Surgery

SURGERY FOR CONGENITAL HEART DISEASE

Reversible pulmonary trunk banding with a balloon catheterAssessment of rapid pulmonary ventricular hypertrophy

From the Heart Institute (InCor),^a University of São Paulo Medical School, São Paulo, Brazil, and the University of Maryland School of Medicine,^b Baltimore, Md.

Poster presented at The Second World Congress of Pediatric Cardiology and Pediatric Cardiac Surgery, Honolulu, Hawaii, May 1997.

Address for reprints: Renato S. Assad, MD, Heart Institute, University of São Paulo, Division of Surgery, Av Dr Eneas de Carvalho Aguiar, 44, São Paulo, SP Brazil 05403-000 (E-mail: rsassad{at}cardiol.br ).

Objective: We sought to assess the rapid hypertrophy of the right ventricle of young goats submitted to progressive pressure load by a balloon catheter.
Methods: The hearts of 6 young goats were assessed by means of echocardiography and cell morphology during and after right ventricular hypertrophy had been produced by a balloon catheter. Myocardial samples of the right ventricular outflow tract were harvested for microscopic studies. The external diameter of longitudinally sectioned myocytes was measured at the nucleus level. The volume density of mitochondria was also determined. A balloon catheter was then placed through the right ventricular outflow tract in the pulmonary trunk and progressively inflated every 2 days. Postoperative serial echocardiography was performed at intervals of 1 to 2 days. The animals were killed after 2 to 3 weeks of right ventricular training for morphologic analysis.
Results: Under optical microscopy, there was a 20.5% increase in the mean diameter of the myocyte of the trained right ventricle. However, under electron microscopy, there was no significant change in the mean volume density of mitochondria from the trained right ventricle. Serial echocardiography showed equalization of the ventricular thickness over a short interval of 6 to 10 days of progressive balloon inflation.
Conclusions: The balloon catheter permits the manipulation of the pressure load over the right ventricle, causing rapid hypertrophy in a 6- to 10-day period. This study suggests that nonsurgical preparation of the "pulmonary ventricle" in patients with transposition of great arteries with intact ventricular septum beyond the neonatal period could probably be accomplished within a very few days.

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