J Thorac Cardiovasc Surg 1994;107:1530-1531
© 1994 Mosby, Inc.
Documented growth of autogenous pulmonary valve translocated to the aortic valve position
J. T. Walls , MD,
W. C. McDaniel , PhD,
E. R. Pope , DVM, MS,
R. E. Fish , DVM, PhD,
G. C. Flaker , MD,
J. J. Curtis , MD,
J. R. Turk , DVM, PhD,
C. C. Wagner-Mann , DVM, PhD
Division of Cardiothoracic Surgery
University of Missouri Health Sciences Center
Columbia, MO 65212
To the Editor:
Transfer of the patient's own pulmonary valve to the aortic position was pioneered by Donald Ross
1 in 1967. Follow-up assessment revealed durability of the autograft, and the procedure has gained acceptance.
To assess the growth potential for the autograft, a Yorkshire-cross pig weighing 39 kg was anesthetized, and hypothermic cardiopulmonary bypass and elective cold potassium cardioplegic arrest were established. The pulmonary artery was transected 1 cm proximal to its bifurcation, the right ventricle was incised, and the intact pulmonary artery and valve were removed with a 5 mm rim of myocardium attached. The aortic valve was excised and the left and right coronary artery ostia were excised leaving a 5 mm rim of aorta attached. The pulmonary artery diameter and intercommissure distances and cusp heights were measured, the pulmonary artery and valve conduit was anatomically oriented, and the autograft was implanted into the aortic anulus with multiple interrupted 5-0 Ethibond sutures (Ethicon, Inc., Somerville, N.J.). The distal anastomosis was performed with a continuous 4-0 Prolene suture (Ethicon). The coronary artery ostia were sewn into incisions in the pulmonary autograft sinuses of Valsalva with continuous 5-0 Prolene sutures. The pulmonary valve was replaced with a cryopreserved pulmonary artery homograft. Continuous 4-0 Prolene sutures were used for the proximal and distal anastomoses.
The animal was allowed to grow to 91 kg during an observation period of 3
months and was then killed. The animal received humane care in compliance with the "Principles of Laboratory Animal Care" formulated by the National Society for Medical Research and the "Guide for the Care and Use of Laboratory Animals" prepared by the National Academy of Sciences and published by the National Institutes of Health (NIH Publication No. 80-23, revised 1978).
Examination revealed enlargement of the autografted pulmonary artery and valve in the aortic position. No evidence of aortic valve stenosis or insufficiency was detected. The cusps were pliable (Fig. 1) and coaptation was good (Fig. 2). Measurements are given in Table I. Enlargement of the translocated pulmonary valve, totally in harmony with that of the nontranslocated structures, is evidence of growth of the translocated valve, not dilation.
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Fig. 1. Pig pulmonary artery and valve autograft in aortic position 3 months after implantation. Pliable valve cusp and coronary artery anastomosis can be seen.
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Fig. 2. Pig pulmonary artery and valve autograft in aortic position 3 months after implantation. Valve has been opened. Cusp coaptation is good. No evidence of valve stenosis or insufficiency can be seen.
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References
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Ross DN. Replacement of aortic and mitral valves with a pulmonary autograft. Lancet 1967;2:956-8.[Medline]
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P. H. Schoof, M. G. Hazekamp, G. van Wermeskerken, E. de Heer, J. A. Bruijn, A. Gittenberger-de Groot, and H. A. Huysmans
Disproportionate enlargement of the pulmonary autograft in the aortic position in the growing pig
J. Thorac. Cardiovasc. Surg.,
June 1, 1998;
115(6):
1264 - 1268.
[Abstract]
[Full Text]
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