Correzione dell'insufficienza polmonare con homograft criopreservato: Ottima soluzione ad un problema post-chirurgico non raro

Translated title of the contribution: Surgical treatment of pulmonary regurgitation with a cryopreserved homograft: A good solution for a not rare post-surgical complication

F. Nicolini, P. Presbitero, E. Cecchi, R. Gallotti

Research output: Contribution to journalArticle

Abstract

Although the results of surgical repair for congenital pulmonary stenosis are generally good, some patients develop progressive symptoms related to pulmonary regurgitation and right ventricular dilation. Pulmonary homograft implantation may have a beneficial effect on these symptoms, due to a reduction in the volume overload of the right ventricle and hemodynamic improvement. We describe our experience of one patient with severe pulmonary regurgitation following pulmonary valvotomy performed with the Brock technique during childhood because of pulmonary valve stenosis. The patient was admitted to our institution because of dyspnea on exertion (NYHA functional class II-III) and paroxysmal episodes of supraventricular arrhythmias. Echocardiography showed severe pulmonary regurgitation, an important right ventricular dilation associated with severe tricuspid insufficiency and a patent foramen ovale without any significant shunts. Surgical repair was performed through a median sternotomy with cardiopulmonary bypass and moderate hypothermia. The right ventricular infundibulum was opened and a cryopreserved pulmonary homograft was implanted with continuous sutures. De Vega annuloplasty was performed on the tricuspid valve and the patent foramen ovale was closed with a running suture. Postoperative course was uneventful and the patient was discharged on the seventh postoperative day. Three months after surgery the patient is asymptomatic and echocardiographic evaluation shows no evidence of pulmonary or tricuspid regurgitation, a decrease in right ventricular dilation and a significant improvement in biventricular systolic and diastolic function. In conclusion, pulmonary regurgitation after surgical valvotomy can be treated with the implantation of a cryopreserved pulmonary homograft with satisfactory results. It would appear advisable to perform surgical repair of concomitant right heart anomalies, such as secondary tricuspid insufficiency, to obtain both a decrease in right ventricular overload and a regression of its preoperative dilation.

Original languageItalian
Pages (from-to)126-129
Number of pages4
JournalItalian Heart Journal Supplement
Volume1
Issue number1
Publication statusPublished - 2000

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Pulmonary Valve Insufficiency
Allografts
Dilatation
Patent Foramen Ovale
Lung
Pulmonary Valve Stenosis
Sutures
Therapeutics
Tricuspid Valve Insufficiency
Tricuspid Valve
Sternotomy
Pituitary Gland
Hypothermia
Cardiopulmonary Bypass
Dyspnea
Heart Ventricles
Echocardiography
Cardiac Arrhythmias
Hemodynamics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Correzione dell'insufficienza polmonare con homograft criopreservato : Ottima soluzione ad un problema post-chirurgico non raro. / Nicolini, F.; Presbitero, P.; Cecchi, E.; Gallotti, R.

In: Italian Heart Journal Supplement, Vol. 1, No. 1, 2000, p. 126-129.

Research output: Contribution to journalArticle

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abstract = "Although the results of surgical repair for congenital pulmonary stenosis are generally good, some patients develop progressive symptoms related to pulmonary regurgitation and right ventricular dilation. Pulmonary homograft implantation may have a beneficial effect on these symptoms, due to a reduction in the volume overload of the right ventricle and hemodynamic improvement. We describe our experience of one patient with severe pulmonary regurgitation following pulmonary valvotomy performed with the Brock technique during childhood because of pulmonary valve stenosis. The patient was admitted to our institution because of dyspnea on exertion (NYHA functional class II-III) and paroxysmal episodes of supraventricular arrhythmias. Echocardiography showed severe pulmonary regurgitation, an important right ventricular dilation associated with severe tricuspid insufficiency and a patent foramen ovale without any significant shunts. Surgical repair was performed through a median sternotomy with cardiopulmonary bypass and moderate hypothermia. The right ventricular infundibulum was opened and a cryopreserved pulmonary homograft was implanted with continuous sutures. De Vega annuloplasty was performed on the tricuspid valve and the patent foramen ovale was closed with a running suture. Postoperative course was uneventful and the patient was discharged on the seventh postoperative day. Three months after surgery the patient is asymptomatic and echocardiographic evaluation shows no evidence of pulmonary or tricuspid regurgitation, a decrease in right ventricular dilation and a significant improvement in biventricular systolic and diastolic function. In conclusion, pulmonary regurgitation after surgical valvotomy can be treated with the implantation of a cryopreserved pulmonary homograft with satisfactory results. It would appear advisable to perform surgical repair of concomitant right heart anomalies, such as secondary tricuspid insufficiency, to obtain both a decrease in right ventricular overload and a regression of its preoperative dilation.",
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