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The Journal of Thoracic and Cardiovascular Surgery, Vol 102, 171-177, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
S Chauvaud, V Jebara, JC Chachques, B el Asmar, S Mihaileanu, P Perier, G Dreyfus, J Relland, JP Couetil and A Carpentier
Preliminary experimental studies in our laboratory have shown that
autologous pericardium treated with glutaraldehyde prevents late
deterioration and calcification of the tissue. For this reason,
glutaraldehyde-treated autologous pericardium has been used in a series of
64 patients who underwent operations for leaflet extension of the mitral
valve between 1980 and 1989. Ages ranged from 2.5 to 60 years (mean 19 +/-
15). The causes of mitral valve insufficiency were rheumatic fever (69%),
bacterial endocarditis (17%), congenital (8%), endomyocardial fibrosis
(4.5%), and trauma (1.5%). The autologous tissue was fixed in a 0.62%
glutaraldehyde solution for 15 minutes and rinsed in saline for an
additional 15 minutes. Patching techniques varied depending on the site and
the extent of the lesion. Associated mitral valve repair techniques
(Carpentier's techniques) were mandatory in all patients. The period of
follow-up extended from 6 months to 9 years (mean 3.1 +/- 2.5 years). There
were no operative deaths in this series, and there was one late death (2%).
In the six patients (12%) who underwent reoperation, there has been no case
of calcification of the pericardial patch. Postoperative mitral valve
function was assessed by bidimensional color Doppler echocardiographic
techniques. Mitral valve insufficiency was trivial or absent in 80% of the
patients. This experience permits us to conclude that leaflet extension is
a simple and safe technique in valve reconstruction, allowing repair of
mitral valves that otherwise would need to be replaced. It permits use of
an adult-size prosthetic ring in children. Glutaraldehyde-treated
autologous pericardium is the material of choice for this type of repair.
ARTICLES
Valve extension with glutaraldehyde-preserved autologous pericardium. Results in mitral valve repair
Hopital Broussais, Service de Chirurgie Cardiovasculaire, Paris, France.
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