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The Journal of Thoracic and Cardiovascular Surgery, Vol 83, 584-589, Copyright © 1982 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
KC Agarwal, WD Edwards, RH Feldt, GK Danielson, FJ Puga and DC McGoon
An autopsy study was conducted of 14 cardiopulmonary specimens in which
porcine-valved extracardiac conduits had been placed from the right
ventricle to the pulmonary artery. The gross and light microscopic
appearance of the tissue lining in such conduits was evaluated. In no
instance was the lining considered obstructive. The conduits had been in
place for varying lengths of time ranging from 1 day to 5 years. The
neointima appeared to begin developing as early as the first postoperative
day as a thin layer of platelet-fibrin thrombus, followed by incorporation
of red blood cells and a few leukocytes. Between 2 to 3 weeks
postoperatively, such shallow thrombotic linings had become organized by
fibroblastic migration and proliferation from both the proximal and distal
anastomosis sites. However, incomplete development of the neointima
frequently led to fenestrations. Peels, or neointimae, older than 1 month
did not change, having densely fibrous luminal surfaces and having thrombus
or necrotic thrombotic debris along the interface between the conduit and
peel. These findings support the concept that progressive thickening of the
lining peel takes place primarily along the interface between the peel and
the conduit rather than the interface between the peel and the lumen.
ARTICLES
Pathogenesis of nonobstructive fibrous peels in right-sided porcine- valved extracardiac conduits
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