Fariba Chalajour, MD, Laura A

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Reconstruction of Pulmonary Artery in a Newborn Using a Porcine Small Intestinal Submucosal Patch Fariba Chalajour, MD, Laura A. Barboza, MD, Lorenzo Boni, MD, Radhika Snyder, BA, Frank L. Hanley, MD, V. Mohan Reddy, MD, R. Kirk Riemer, PhD The Annals of Thoracic Surgery Volume 93, Issue 4, Pages 1311-1315 (April 2012) DOI: 10.1016/j.athoracsur.2011.08.055 Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Histologic and immunohistologic analysis of porcine small intestinal submucosa (SIS) patch explants. (A) Hematoxylin and eosin staining shows the vascularized structure of the patch. (B) Hypercellularization and vascularization of the SIS patch was detected in the transitional area. (C) The von Willebrand factor (vWF) was expressed in the cells covering the luminal site of the SIS patch. (D) Expression of smooth muscle actin (SMA) was observed in the medial layer. Vascularization of adventitia was confirmed by expression of (E) vWF, and (F) SMA. (Magnifications: A, 50×; B, 400×; C-D, 1,000×; E-F, 400×; PA = pulmonary artery). The Annals of Thoracic Surgery 2012 93, 1311-1315DOI: (10.1016/j.athoracsur.2011.08.055) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Activation of vasculogenesis and angiogenesis in the small intestinal submucosa (SIS) patch explants. Contribution of CD34 positive cells in formation of (A) cordlike structures, which were filled with (B) mature CD31 positive cells, and surrounded by (C) smooth muscle actin (SMA) positive cells. Anastomosis between nonperfused and perfused vessels is shown by (D) hematoxylin and eosin staining. (E) Immunofluorescence double staining for CD31 and SMA confirmed the absence of blood perfusion in some of the vessels whereas the new vessels growing from preexisting vessels contained (F) red blood cells (white arrows). (Magnifications: A-D, 400×; E-F, 1,000×; DAPI = 4',6-diamidino-2-phenylindole; RBC = red blood cells; vWF = von Willebrand factor.) The Annals of Thoracic Surgery 2012 93, 1311-1315DOI: (10.1016/j.athoracsur.2011.08.055) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Growth potential of the small intestinal submucosal (SIS) patch. (A) Expression of stem cell marker c-kit (A) and (B) proliferation marker PCNA (proliferating cell nuclear antigen) is identified in the SIS patch explants. (C) Immunofluorescence double staining showed coexpression of c-kit and PCNA in a few cells, indicating proliferation capacity of c-kit positive cells (white arrows). (D) Immunofluorescence double staining for CD31 and c-kit showed presence of c-kit positive cells around the new vessels but not in the vessel wall. (Magnifications: A-B, 400×; insets 1,000×; C-D, 1,000×; DAPI = 4',6-diamidino-2-phenylindole; RBC = red blood cells; vWF = von Willebrand factor.) The Annals of Thoracic Surgery 2012 93, 1311-1315DOI: (10.1016/j.athoracsur.2011.08.055) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions