The pericardial membrane pulmonary monocusp: Surgical technique and early results

Long-term pulmonary insufficiency resulting from simple transannular patchi ng of the right ventricle outflow tract will ultimately lead to deteriorati on in right ventricular function. Previously, monocusps constructed from xe nografts, homografts, fascia lata, and autologous pulmonary artery wall hav e been utilized to minimize pulmonary regurgitation and its deleterious eff ect on right ventricular function. However, these tend to degenerate in the long term, necessitating reoperation. To circumvent this problem we have u sed a monocusps constructed from 0.1-mm polytetrafluorethylene (PTFE, peric ardial membrane) clinically demonstrated to be resistant to issue ingrowth and degeneration. Seven children (5 tetralogy of Fallot, 2 pulmonary stenos is) who required division of a small pulmonary annulus underwent monocusp c onstruction with 0.1-mm PTFE. Three patients had previous corrective surger y. One of these patients had a bovine pericardial monocusp placed 8 years p reviously, which degenerated. Of the remaining two patients, one had a pulm onary valvotomy as a neonate, the other repair of tetralogy of Fallot with a transannular patch. At a mean (+/- standard deviation) follow up to 17 +/ - 5.8 months all patients are alive and are New York Heart Association (NYH A) Class I. Echocardiography demonstrates mild pulmonary insufficiency (PI) in 2 patients, mild to moderate PI in 4, and moderate to severe PI in 1. T he presence of a pericardial membrane monocusp in the pulmonary position ma y, in the long term, prevent the deleterious effects of transannular patchi ng on right ventricular dysfunction and be more resistant to degenerative c hanges characteristic of monocusps constructed of native pericardium or all ogeneic tissue.