A novel method to reduce pericardial adhesion: A combination technique with hyaluronic acid biocompatible membrane Yuji Naito, MD, Toshiharu Shin'oka,

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Presentation transcript:

A novel method to reduce pericardial adhesion: A combination technique with hyaluronic acid biocompatible membrane Yuji Naito, MD, Toshiharu Shin'oka, MD, PhD, Narutoshi Hibino, MD, PhD, Goki Matsumura, MD, PhD, Hiromi Kurosawa, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 135, Issue 4, Pages 850-856 (April 2008) DOI: 10.1016/j.jtcvs.2007.10.062 Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 The adhesion tissue thickness analysis. The neotissue fibrils, which consist of dense collagenous fiber, could be distinguished from myocardium microscopically in Masson trichrome stain. The image of each tissue was analyzed by National Institutes of Health image, and the area of adhesion tissue was calculated. ePTFE, Expanded polytetrafluoroethylene. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 850-856DOI: (10.1016/j.jtcvs.2007.10.062) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Three months after the initial operation, moderate-to-severe tenacious adhesions were observed between the epicardium and the ePTFE patch in group A (A), whereas the adhesion formation in group B was extremely low, with several fibrous strands formed on the epicardial surface (B). In group C, marked adhesion formation, which was difficult to dissect out, was observed in the pericardial cavity (C). In group D, almost no adhesion was formed in the pericardial cavity, and the epicardium was almost intact, which made the coronary vessels clearly identifiable (D). The Journal of Thoracic and Cardiovascular Surgery 2008 135, 850-856DOI: (10.1016/j.jtcvs.2007.10.062) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Mean adhesion tenacity score (A) and mean adhesion tissue thickness (B). ∗P < .05, ∗∗P < .01, respectively, by the Scheffé test. †P < .01 by the Fisher PLSD test. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 850-856DOI: (10.1016/j.jtcvs.2007.10.062) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 In group A, a thick layer of neotissue fibrils (NTF) was observed between expanded polytetrafluoroethylene (ePTFE) and epicardium (A). In group B, the surface of NTF on ePTFE sheet was covered with a mesothelium-like lining (arrows) (B1, B2). In group C, a moderately thick layer of NTF with small arteries was noted between the epicardium and pericardium (C). In contrast, a very thin layer of NTF was formed on the surface of epicardium in group D (D1). A mesothelium-like lining (arrows) was identified on the surface of NTF (D2). AT, Adipose tissue; AT in PC, adipose tissue in pericardium; Myo, myocardium; HE, Hematoxylin–eosin stain; MT, Masson trichrome stain. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 850-856DOI: (10.1016/j.jtcvs.2007.10.062) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Immunohistochemically stained mesothelial cells. In group D, a single layer of mesothelial cell lining (arrows) on the whole surface of neotissue fibrils (NTF) was observed (A). In group B, several mesothelial cell linings (arrows) on NTF were recognized in the same way as group D (B). ePTFE, Expanded polytetrafluoroethylene. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 850-856DOI: (10.1016/j.jtcvs.2007.10.062) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions