Masahiro Yoshida, MD, Peter D

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Right Ventricular Outflow Tract Reconstruction With Bicuspid Valved Polytetrafluoroethylene Conduit Masahiro Yoshida, MD, Peter D. Wearden, MD, PhD, Onur Dur, MS, Kerem Pekkan, PhD, Victor O. Morell, MD The Annals of Thoracic Surgery Volume 91, Issue 4, Pages 1235-1239 (April 2011) DOI: 10.1016/j.athoracsur.2010.11.010 Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 The authors use various sizes of conduit from 10 to 24 mm in diameter. This graft shows the correlation between conduit size and body surface area (BSA). The curved line shows normal pulmonary valve size by Rawlatt. The Annals of Thoracic Surgery 2011 91, 1235-1239DOI: (10.1016/j.athoracsur.2010.11.010) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Drawings of the steps to make a bicuspid valved conduit. At first, a polytetrafluoroethylene (PTFE) conduit with standard stretch wall is turned inside out. After holding the graft at both ends using Kelly's clamps, two cusps trimmed from the PTFE sheet of 0.1-mm thickness are sutured using 6-0 or 7-0 polypropylene sutures. Actually, the author put the top of the triangle first and put marking stitches at the middle of both sides. Then, continuous suture is put using the stitch of the top. After completion of suturing two cusps, the conduit is turned back outside in (upper drawings). A special feature of this conduit is having a nonvalved portion at the bottom (lower drawings). The Annals of Thoracic Surgery 2011 91, 1235-1239DOI: (10.1016/j.athoracsur.2010.11.010) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The design of each valve. The figures are as follow: circumference (C) = conduit size × 3.14; nonvalved portion (nV) = C × 0.15; width of sinus (WS) = (C − nV ) / 2; height of sinus (HS) = WS × 0.7; width of cusp (WC) = WS × 1.2; height of cusp (HC) = HS × 0.9; and fan of cusp (FC) = HC × 0.2. The Annals of Thoracic Surgery 2011 91, 1235-1239DOI: (10.1016/j.athoracsur.2010.11.010) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Pressure gradients of conduit in the operating room (OR), at discharge, and at clinic by echocardiography. The Annals of Thoracic Surgery 2011 91, 1235-1239DOI: (10.1016/j.athoracsur.2010.11.010) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Echocardiography the author experienced in Kobe, Japan. The stuck valve at the bottom of tricuspid valved conduit is shown (arrowhead). It was considered that flow velocity at the lesser curvature of the curved conduit was slower than at the major curvature. The Annals of Thoracic Surgery 2011 91, 1235-1239DOI: (10.1016/j.athoracsur.2010.11.010) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Newtonian pulsatile blood flow simulated inside the 14-mm conduit for a cardiac output of 1.2 LPM using second-order computational fluid dynamics solver (Fluent 6.3.26). Time-averaged velocity contours shown during systole indicated lower velocity at the lesser curvature of the conduit. The Annals of Thoracic Surgery 2011 91, 1235-1239DOI: (10.1016/j.athoracsur.2010.11.010) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions