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J Thorac Cardiovasc Surg 1999;118:384-385
© 1999 Mosby, Inc.
LETTERS TO THE EDITOR |
Department of Cardiothoracic Surgery
Faculty of Medicine
University of Tokyo
7-3-1, Hongo, Bunkyo-ku
Tokyo, 113-8655, Japan
JR Tokyo General Hospitala
2-1-3, Yoyogi, Shibuya-ku
Tokyo, 151-8528, Japan
12/8/99093
To the Editor:
The case history of a patient with a Hancock porcine heterograft valve (Medtronic, Inc, Minneapolis, Minn) implanted 22 years ago was reported by Wisheart.
1 In 1971, we 2 reported the replacement of a tricuspid valve with a preserved aortic valve homograft for Ebstein’s malformation. After 28 years, the patient is still alive and active with the homograft.
A 12 year-old girl was admitted to our hospital for mild exertional dyspnea and polycythemia. On June 18, 1970, she underwent tricuspid valve replacement with an aortic homograft and suture closure of the atrial septal defect. The homograft was preserved in 70% alcohol for 7 weeks and was fixed to a Shumway-Angell ring (No. 26) by 2-layer continuous sutures. The reinforced valve was anchored to the "true anulus" of the tricuspid valve with interrupted sutures so as to leave the coronary sinus above it. No diastolic pressure gradient was detected between the right atrium and the ventricle. She was discharged from the hospital with sinus rhythm and has enjoyed an active life.
The woman is now 41 years old and visited the outpatient clinic for a follow-up study after 28 years. Physical examination revealed no cyanosis and only a Levine grade 2/6 diastolic murmur over the precordium. An electrocardiogram showed complete atrioventricular block with a ventricular rate of 60 beats/min. Her condition was New York Heart Association class II. Echocardiographic study revealed a well-functioning homograft without evidence of calcification (Fig 1). A diastolic pressure gradient between the right atrium and the ventricle was estimated as 5 mm Hg. A color Doppler study showed moderate tricuspid regurgitation.
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3 reported that the longest surviving homograft conduit was 22.7 years in his series of patients with subpulmonary homograft conduits. Recently, Rizzoli and coauthors 4 reported long-term results of prosthetic valve replacement in the tricuspid position, and the longest survival time was 27.8 years after insertion of a mechanical valve. However, the very long-term result of homografts in the right side of the heart is still unknown. Between 1967 and 1969, 5 patients survived the operation in our hospital with homografts in the aortic or tricuspid position. All 4 homografts in the aortic position were replaced within 9 years, 3 because of valve malfunction and 1 because of infectious endocarditis. On the other hand, the valve in the tricuspid position is still functioning, probably because of the low mechanical stress to the valve leaflets in the right side of the heart. In conclusion, the experience with our patient for more than a quarter of a century suggests the feasibility of homograft use in the tricuspid position, even in adolescents.
References
This article has been cited by other articles:
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  A. Kalangos, J. Sierra, M. Beghetti, P. Trigo-Trindade, D. Vala, and J. Christenson Tricuspid valve replacement with a mitral homograft in children with rheumatic tricuspid valvulopathy J. Thorac. Cardiovasc. Surg., June 1, 2004; 127(6): 1682 - 1687. [Abstract] [Full Text] [PDF]
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