PULMONARY VALVE RECONSTRUCTION IN ABSENT PULMONARY VALVE SYNDROME - ANEW TECHNIQUE

Background: In patients with absent pulmonary valve syndrome, the reli ef of the pulmonary regurgitation at the time of primary repair improv es both the early and late results. Though homograft and heterograft v alves and conduits have been used for this purpose, both ave not easil y available and are known for late failure. Monocusp and bicuspid semi lunar valves made out of pericardium have their own problems. Hence, a technique of reconstructing an autologous competent 3-cusp valve from the native tissues was developed. Methods: Two posterolateral semilun ar cusps were fashioned from the anterior wall of the main pulmonary a rtery. The anterior cusp was made from autologous pericardium stitched to the autologous pericardial patch used to widen the right ventricul ar outflow tract. Results: This method of reconstruction was used in t wo patients aged 9 and 22 years, respectively. Visual assessment and p assive testing after reconstruction revealed well functioning neopulmo nary valves in both patients. The second patient, who had an unevenful hospital course, showed only mild pulmonary regurgitation at 5 years postreconstruction. Conclusions: As 2 of the 3 cusps are fashioned fro m the pulmonary arterial wall as a pedicled graft, we believe that the y will retain their viability and grow with the pulmonary artery Simul taneous reduction in the size of the pulmonary arteries will relieve b ronchial compression when present. The anterior pericardial cusp, even ii it eventually shrivels up, is unlikely to produce serious hemodyna mic derangements.