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J Thorac Cardiovasc Surg 2007;133:646-647
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Discussion

Dr J. Brown (Indianapolis, Ind). We at Indianapolis completely agree with your comments that you should try to reconstruct the pulmonary valve every time you have to cross the annulus. We have used the polytetrafluoroethylene (Gore-Tex; WL Gore and Associates, Flagstaff, Ariz) monocusp.

The illustrations in your presentation look similar to the illustrations of the monocusp with the exception that you sew the edge of your pericardial patch augmentation to the residual cut edges of the leaflet that you cut across. And when your annulus is only 6 mm, and I look at those valves, they’re so dysplastic, sewing a pericardial patch to the edges of the leaflets just seems kind of difficult in a 3-, 4-, or 5-month-old child. So I wonder, the patches that you actually sew into these patients must be much wider than the rest of the cusps put together to get an annulus diameter big enough for that child.

When we originally started using polytetrafluoroethylene (Gore-Tex) monocusps, we sewed them to the pulmonary artery wall rather than the residual leaflet tissue. They were big enough to be draped across the back of the RVOT so that it made it a monocusp. How do your patch dimensions compare with our polytetrafluoroethylene (Gore-Tex) monocusps? We know that our polytetrafluoroethylene (Gore-Tex) monocusps last 2 or 3 years, and I am interested to find out whether these pericardial cusp augmentations will last even a longer period of time. So that’s the first question. Is there really a difference between your technique and what we’ve been doing for 10 or 12 years?

Dr Anagnostopoulos. I think the difference is that by suturing the pericardial tissue into the native valve apparatus, we try to use the hinge mechanism of the valve and make it coapt with the rest of . . . [Full Text of this Article]

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