Long-term results of the gamma-irradiation-preserved homograft monocusp for transannular reconstruction of the right-ventricular outflow tract in tetralogy of Fallot

The long-term results of a consecutive series of transannular gamma-irradiated homograft monocusp patches in tetralogy of Fallot were studied. Seven survivors out of 8 patients are doing clinically well after a mean of 22.4 years of follow-up, 5 of them being in New York Heart Association class I and 2 in class II. In one patient the completely calcified gamma-irradiated homograft monocusp patch was replaced 15 years after intracardiac repair. Echocardiographic investigation at the end of follow-up of the remaining 6 patients with a gamma-irradiated homograft monocusp patch in situ showed mild pulmonary regurgitation in 1, moderate regurgitation in 3, and severe regurgitation in 2. Residual pulmonary stenosis was present in 4 patients (gradients ranging from 10 to 40 mmHg). Right-ventricular dilatation was present in all patients. In the long-term the gamma-irradiated transannular homograft monocusp patch behaves like a simple transannular patch.     

Monocusp homograft VSD patch in atrioventricular canal with tetralogy of Fallot

A monocusp aortic homograft was used to compensate for deficient right atrioventricular valve tissue during repair of complete atrioventricular canal defect with tetralogy of Fallot. The homograft was used to produce a comma-shaped ventricular septal defect patch together with the septal leaflet of the right atrioventricular valve, thus committing native leaflet tissue to left atrioventricular valve reconstruction. One year postoperatively the child is in New York Heart Association class I with no tricuspid regurgitation.     

Homografts in congenital heart disease: current applications and future directions

The first clinical use of homograft tissue in cardiovascular surgery was in 1948, when Gross used cadaveric arterial grafts to construct systemic to pulmonary artery shunts in patients with tetralogy of Fallot, and to repair coarctation of the aorta. Eighteen years later, a valved homograft was used for the first time in the treatment of congenital heart disease for reconstruction of the right ventricular outflow tract in a child with pulmonary atresia. Since these pioneering advances, valve and vascular homografts have become central to the management of congenital anomalies of the heart and great vessels. The primary use for homografts in congenital heart surgery today is establishment of a valved connection between the right ventricle and pulmonary arteries in children with tetralogy of Fallot with pulmonary atresia or other complicating factors, truncus arteriosus, transposition complexes, and double-outlet right ventricle, and in patients undergoing the Ross procedure. Homograft reconstruction of the left ventricular outflow tract has also been performed for many years in children with aortic insufficiency or recurrent aortic stenosis, but early homograft degeneration in young children has been a significant problem. Many surgeons are turning away from homografts in the systemic circulation in favor of the pulmonary autograft. Homograft is also widely used as a vascular patch material. In the present report, we discuss the various uses of homografts in congenital heart surgery, the benefits and drawbacks of homografts in young patients, and some of the future possibilities for homograft development and application in patients with congenital heart disease.     

The effect of alpha-melanocyte-stimulating hormone and its analog on the growth of human melanoma cell lines with different phenotypes

Homograft aortic root replacement was done to three patients and the anterior mitral leaflet of the homograft was used with success in all cases. Case 1. A 37-year-old man had late-onset active prosthetic valve endocarditis with a fistula from the aortic annulus to the left atrium. The fistula was closed by using a homograft anterior mitral leaflet and the aortic root was replaced by a homograft with reimplantation of the coronary arteries. He is very well without evidence of recurrent endocarditis 29 months after the operation. Case 2. A 37-year-old man had early-onset active prosthetic valve endocarditis and developed the same fistula as case 1. He was treated successfully as in case 1. He is very well 4 months after the operation. Case 3. A 50-year-old woman, who had undergone aortic commissurotomy due to aortic valvular stenosis fifteen years before, deteriorated again. She had subvalvular membranous stenosis and a small aortic annulus. Konno-Soma procedure was applied to enlarge the annulus and the aortic root was replaced by a homograft. The interventricular septal incision was closed successfully with use of the anterior mitral leaflet of the homograft. Homograft aortic root replacement was an attractive procedure for prosthetic valve endocarditis or a small aortic annulus, and the homograft anterior mitral leaflet was useful for closing the fistula due to the infection and for closing the interventricular septal incision of Konno-Soma procedure.     

Use of the "chimney patch" technique for Norwood stage I procedures

The Norwood stage I procedure is often used for the initial treatment of infants with hypoplastic left heart syndrome. This procedure creates a systemic arterial to pulmonary artery shunt to establish pulmonary blood flow. We describe a method to facilitate placement of this shunt by attaching a polytetrafluoroethylene shunt to a pulmonary artery homograft patch before performing the median sternotomy. This technique facilitates the performance of the proximal shunt anastomosis and expedites the procedure.     

Spontaneous obliteration of a pseudo-aneurysm complicating an aortic homograft

Pseudoaneurysm formation after aortic homograft replacement in patients with active endocarditis is a common observation and usually occurs at the site of a former abscess or paravalvular leak in case of prosthetic valve endocarditis. A 53-year-old man with prosthetic endocarditis underwent aortic valve homograft replacement and developed a pseudoaneurysm at the right and noncoronary aortic sinus which was documented by Doppler echocardiography. Follow-up examination ten months after operation unexpectedly revealed a complete obliteration of the previously echo free space between the homograft and the native aortic root and, thus, spontaneous obliteration of the pseudoaneurysm.     

Preperitoneal suprahepatic pacemaker generator placement in the pediatric population

We report a case of partial replacement of the tricuspid valve by a mitral homograft in a young drug addict with right heart endocarditis. Operation was indicated because of sudden severe tricuspid regurgitation and persistence of vegetations despite appropriate antibiotic therapy. Partial tricuspid valve replacement was performed with a segment of mitral homograft reinforced by a semirigid prosthetic ring. At 30-month postoperative follow-up the patient was in excellent clinical condition with a satisfactory echocardiographic result.     

Renal staghorn calculosis: our experience with the percutaneous treatment with or without extracorporeal shock wave lithotripsy

Signs of the left bronchus compression, caused by aneurysmatic dilatation of the aortic root with severe aortic regurgitation, occurred 5 months after repair of the truncus arteriosus with interrupted aortic arch in an 85-day-old infant. At reoperation the dilated ascending aorta was replaced with a 14-mm Dacron tube. The aortic valve was replaced with an 18-mm Carbomedics valve. Compression of the left bronchus and the right pulmonary artery were released. The right pulmonary artery was enlarged with a pericardial patch and the original homograft was replaced with a new one. The patient remains in good clinical condition 2 years later.     

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The technique of homograft aortic root replacement in our practice has evolved as our experience has increased. This technique is described and illustrated. In most cases, aortic annuli are reduced by using various suture techniques to match the homograft. This allows for a successful implantation of a normal-sized aortic homograft root in a patient with a diseased aortic valve and annular dilatation.     

Can patient retention of rectal barium be guaranteed?

Homograft replacement of the aortic valve in cases of acute bacterial endocarditis is considered the ideal choice because of the resistance of the homograft to reinfection. We report a case of aortic and mitral valve bacterial endocarditis, secondary to Streptococcus viridans, with severe aortic and mitral valve regurgitation and hemodynamic instability requiring surgical interventions with the use of aortic and mitral valve homografts.     

Mitral valve replacement using a cryopreserved mitral homograft

Mitral valve replacement, using a cryopreserved mitral homograft, was performed in a 49-year-old patient with calcified mitral stenosis. Postoperative course was uneventful. Transesophageal echocardiography performed 6 months later showed normal function of the mitral homograft.     

Diagnosis of stenosis in a pulmonary valve-conduit using an angioplasty guide and probing catheter

A 42-year-old man who had undergone previous Blalock-Taussig anastomoses and placement of a homograft aortic valve-root conduit for tetralogy of Fallot presented with dyspnea at rest. Previous catheterization had shown homograft stenosis at the level of the pulmonic valve. Repeat catheterization necessitated the use of angioplasty guide and probing catheters to cross the stenosis, and pullback documented stenoses both across the homografted valve and within the homograft aortic root-native pulmonary artery conduit.     

Synthetic patch for scleral tissue loss

We report a case in which traumatic scleral tissue loss was surgically treated by a synthetic patch used in neurosurgical procedures. In the present case the patch served as a permanent solution to scleral loss. The patch is available commercially and easily stored. In the light of our experience, we suggest that this patch material be considered for both urgent and semi-elective scleral patching procedures.     

Comparison of a 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino)carbonyl]-2H-t etrazolium hydroxide (XTT) colorimetric method with the standardized National Committee for Clinical Laboratory Standards method of testing clinical yeast isolates for susceptibility to antifungal agents

We report here a case of concomitant aortic and tricuspid valve endocarditis occurring in a 26-year-old woman 2 weeks after she had given birth by cesarean delivery. Preoperative transthoracic echocardiography revealed a previously undetected aorta-right atrium fistula, which at operation appeared to be congenital in origin. Surgical treatment consisted of aortic valve replacement with a pulmonary autograft, tricuspid valve replacement with a cryopreserved mitral homograft, and closure of the fistulous communication. The postoperative recovery was uneventful.     

Isolation of Mycoplasma and unstable L-forms from sporadic bovine mastitis

A case of giant cell aortitis causing ascending aortic aneurysm associated with aortic regurgitation is reported. The aneurysm was excised and the aortic valve replaced using a fresh homograft. The patient has been followed up for three and a half years. There is good evidence of correction of the haemodynamic lesion and no evidence of further arteritis or aneurysmal formation. The pathological and clinical problem of this disease are discussed.     

Homograft replacement of fungal endocarditic pulmonary valve

Right-sided infective endocarditis is uncommon but is increasingly seen as a reflection of the prevalence of drug abuse, chronic intravenous catheters and associated congenital malformations. Isolated pulmonary valve endocarditis has rarely been reported and there has been only one previous report of isolated pulmonary valve fungal endocarditis. This resolved with antimicrobials. We describe a case of isolated mycotic pulmonary valve endocarditis resistant to existing anti-fungal chemotherapy, which necessitated pulmonary valve resection and replacement with a homograft.     

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A case of early autograft endocarditis occurring three weeks after a Ross operation is described. The origin of the infection appeared to be the proximal suture line of the autograft and the pathology included subvalvular destruction of the autograft, a pseudoaneurysm between the autograft and the left atrium, and a fistula to and a vegetation in the roof of the left atrium. The valve cusps were unaffected and there was only slight autograft insufficiency (grade I-II). The autograft was removed and successfully replaced with a homograft.     

Systolic aortic valve compression from partial dehiscence of an aortic valve homograft

Implantation of valve prostheses provide improvement of symptoms and prolongation of life in selected patients with valvular heart disease. Meticulous follow-up of patients after valve surgery is essential as complications of valve failure, valve dehiscence, valve thrombosis, and infection may occur. The major mode of failure of aortic valve homografts is valve regurgitation, which is readily detected by physical examination. We report a case of left ventricular outflow obstruction after implantation of an aortic valve homograft.     

Aortic homograft and mitral valve repair in a patient with Werner's syndrome

We report the case of a 66-year-old man suffering from Werner's syndrome (adult progeria); he presented with several cardiac disorders, including coronary artery disease, aortic stenosis, and mitral regurgitation, mainly due to calcific deposits in the mitral annulus and the aortic cusps. Treatment consisted of mitral repair, homograft replacement of the aortic valve, and coronary artery bypass grafting. Avoidance of prosthetic material because of chronic infectious skin ulcers constituted the main goal of the operation.