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J Thorac Cardiovasc Surg 2008;136:296-297
© 2008 The American Association for Thoracic Surgery

Invited Commentary

Discussion

Dr J. Brown (Indianapolis, Ind). Dr Nunn and colleagues are to be commended on their development of another relatively simple technique to reconstruct the pulmonary valve with 0.1-mm PTFE membrane in patients who require a transannular patch. I have to admit that studying their illustrations and seeing the video clarified this technique immensely for me. Reading the abstract, I was a little confused. But you did a wonderful job in explaining how this valve works and how it's oriented in the RV outflow tract.

This technique lengthens the leading edge, or free edge, of the reconstructed pulmonary valve and has the potential advantage of enlarging the pulmonary valve to a greater diameter than can be accomplished with a monocusp valve and may shorten the leaflet closing time. The technique also orients the commissures of the new valve in a vertical manner as opposed to the monocusps, where the closure is in the horizontal manner.

The monocusp technique, using this material that my colleagues and I have used successfully at Indiana for more than 13 years and more than 200 patients, allows us to double the circumference of the native RV outflow tract, but it seems that this technique might allow you to enlarge it even further. I have several questions. Do you use aspirin postoperatively in your patients?

Dr Nunn. I haven't.

Dr Brown. Can you make this outflow tract reconstruction too large so that when you close the sternum it's compressed and this would deform this valve?

Dr Nunn. It's possible. But I think that the bileaflets, because they're held apart by that pledgeted suture, would still function . . . [Full Text of this Article]