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J Thorac Cardiovasc Surg 1996;111:683
© 1996 Mosby, Inc.

LETTERS TO THE EDITOR

Reply

Clinic for Thoracic and Cardiovascular Surgery
University Hospital
CH-3010 Berne, Switzerland

Reply to the Editor:

I am pleased to add a brief comment to the well-illustrated case described here by Masiello and colleagues confirming by macroscopic and histologic examination what we called "echo-free perfused space," or pseudoaneurysm. We defined pseudoaneurysm after aortic allograft implantation as echo-free perfused space between the native aortic wall and the residual aortic wall (the left ventricular outflow tract tissue) of the allograft observed on postoperative echocardiography. After fortunate detection of a pseudoaneurysm late after operation in one patient and early detection in another patient who required immediate reoperation, all patients who had allograft implantation were reviewed retrospectively and Doppler echocardiographic examinations were carefully studied.

The development of pseudoaneurysms could not be correlated with the infective status (active or eradicated endocarditis) at the operation, but localization of pseudoaneurysms seems to correlate with the localization of preoperative abscesses or perivalvular leaks (in prosthetic valve endocarditis). The technique of allograft implantation (interrupted or continuous proximal suture line) did not influence subsequent development of echo-free perfused spaces.

After the real incidence of abnormal but mainly insignificant echocardiographic findings was known, our group described the use of fibrin glue in aortic allograft implantation. ¹ Glue is applied immediately after completion of the proximal suture line (at this time, the allograft is still inverted into the left ventricle) and during completion of the distal suture line. There is another advantage of using fibrin glue in patients with active endocarditis at the time of surgery: glue can be mixed with antibiotics, which may help to eradicate valvular and perivalvular infection or to sterilize an abscess cavity. ² However, elimination of echo-free perfused spaces is best realized during implantation of allograft by using the miniroot aortic valve replacement technique.

References

1. von Segesser LK, Oechslin E, Jenni R, Turina M. Use of glue to avoid formation of perfused recesses in aortic allograft implantation. Ann Thorac Surg 1994;57:494-5.[Abstract/Free Full Text]
   
2. Pasic M, von Segesser LK, Turina M. Implantation of antibiotic-releasing carriers and in-situ reconstruction for treatment of mycotic aneurysms. Arch Surg 1992;127:745-6.[Abstract/Free Full Text]
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Carrel, T. Search for Related Content PubMed Articles by Carrel, T.