Heparinization on pericardial substitutes can reduce adhesion and epicardial inflammation in the dog Jen-Her Lu, MD, PhD, Yen Chang, MD, Hsing-Wen Sung,

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Presentation transcript:

Heparinization on pericardial substitutes can reduce adhesion and epicardial inflammation in the dog Jen-Her Lu, MD, PhD, Yen Chang, MD, Hsing-Wen Sung, PhD, Yung-Tang Chiu, DVM, PhD, Ping-Cheng Yang, DVM, PhD, Betau Hwang, MD The Journal of Thoracic and Cardiovascular Surgery Volume 115, Issue 5, Pages 1111-1120 (May 1998) DOI: 10.1016/S0022-5223(98)70411-8 Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 1 The epoxy-fixed patch with ionically bound heparin retrieved 12 weeks after implantation; stain: hematoxylin-eosin. Left, Light micrograph showed focal fibrosis, a scattering of hemorrhagic infiltrations, and occasional lymphocytes and plasma cells. The thin layer of fibrous tissue (F) covered the intact patch (P) and the myocardium (C) (×20). Right, The pleural side of the patch showed fibrous reactive zone (F) over the lung. The epicardial side (epi) of the patch was clear with minimal epicardial fibrous reaction (F) (×l00). The Journal of Thoracic and Cardiovascular Surgery 1998 115, 1111-1120DOI: (10.1016/S0022-5223(98)70411-8) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 2 The epoxy-fixed patch without ionically bound heparin retrieved 12 weeks after implantation; stain: hematoxylin-eosin. Left, Cross section on the surface of the heart. Light micrograph showed dense collagenous fibrosa (F) with strongly folded surface. The epicardial inflammatory zone (2) of the patch (P) was covered with fibrous tissue (F) with edematous reaction (E) (×20). Top right, The inflammatory zone of pleural side (1) of the patch showed dense fibrous tissue. Light micrograph showed focal fibrosis, diffused infiltration of lymphocytes, and plasma cells through epicardial layers (2) (×100). Bottom right, Patch appeared soft and pliable. The epicardial fibrosis (F) could be peeled off easily (×200). CA, Coronary artery; S, suture. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 1111-1120DOI: (10.1016/S0022-5223(98)70411-8) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 3 The glutaraldehyde-fixed patch with ionically bound heparin retrieved 12 weeks after implantation; stain: van Gieson stain. Mild fibrosis was demonstrated with dense collagenous fibrosa (F) on the epicardial surface (epi) of the patch (P). Right, ×20; left, ×100. C, Myocardium; L, lung. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 1111-1120DOI: (10.1016/S0022-5223(98)70411-8) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 4 The glutaraldehyde-fixed patch without ionically bound heparin retrieved 12 weeks after implantation; stain: van Gieson stain. Compared with the heparinized patch in Fig. 3, both the inflammatory (I) and fibrous reaction (F) were more severe in the nonheparinized patch. Left, ×20; right, ×100. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 1111-1120DOI: (10.1016/S0022-5223(98)70411-8) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 5 An ePTFE patch retrieved 12 weeks after the operation; stain: hematoxylin-eosin. Left, On gross examination, dense adhesions with a thick layer of fibrous tissue (F) were present in both sides of the patch (P). The ePTFE patch did not appear shrunken or thickened. Top right, The pleural (1) and epicardial surfaces (2) were thickened. The ePTFE patch itself was intact without fibrous ingrowth. The presence of a tissue-free space (*) around the ePTFE patch (P) could be identified (×20). Bottom right, Histologically, the patch was composed of hyaline and dense fibrous connective tissue. The underlying epicardium (epi) was covered by a dense layer of fibrotic tissue (F) beneath the ePTFE patch (×100). The Journal of Thoracic and Cardiovascular Surgery 1998 115, 1111-1120DOI: (10.1016/S0022-5223(98)70411-8) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 6 A polyester patch (Dacron) retrieved 12 weeks after implantation; stain: hematoxylin-eosin. Left, On gross examination, dense adhesion with a thick layer of fibrous tissue (F) was present in both sides of the Dacron patch (D) (×20). Top right, The Dacron (D) itself appeared shrunken and thickened with a dense fibrous ingrowth (F). Dense adhesions were present between the inflammatory zone of pleural (↔) and epicardial side (↔) (×100). Bottom right, Severe fibrosis was identified (×200). L, Lung; C, myocardium; Epi, epicardial fibrosis. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 1111-1120DOI: (10.1016/S0022-5223(98)70411-8) Copyright © 1998 Mosby, Inc. Terms and Conditions