The Contegra conduit in the right ventricular outflow tract induces supravalvular stenosis Bart Meyns, MD, PhD, Leen Van Garsse, MD, Derize Boshoff,

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Presentation transcript:

The Contegra conduit in the right ventricular outflow tract induces supravalvular stenosis Bart Meyns, MD, PhD, Leen Van Garsse, MD, Derize Boshoff, MD, Benedicte Eyskens, MD, Luc Mertens, MD, PhD, Marc Gewillig, MD, PhD, Steffen Fieuws, Erik Verbeken, MD, PhD, Willem Daenen, MD The Journal of Thoracic and Cardiovascular Surgery Volume 128, Issue 6, Pages 834-840 (December 2004) DOI: 10.1016/j.jtcvs.2004.08.015 Copyright © 2004 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 The number of implanted graft sizes. Smaller sizes were implanted in patients with smaller body surface areas (bsa). One valve was bicuspidized to an 8-mm graft. The Journal of Thoracic and Cardiovascular Surgery 2004 128, 834-840DOI: (10.1016/j.jtcvs.2004.08.015) Copyright © 2004 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Kaplan-Meier curve (95% confidence limits) of the freedom from severe stenosis at the distal anastomosis (peak gradient, >50 mm Hg). The hazard of development of pulmonary stenosis does not decrease significantly over time. The Journal of Thoracic and Cardiovascular Surgery 2004 128, 834-840DOI: (10.1016/j.jtcvs.2004.08.015) Copyright © 2004 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Kaplan-Meier curve of the freedom from severe stenosis at the distal anastomosis (peak gradient, >50 mm Hg) for the small graft sizes (interrupted line) and the large graft sizes (full line). In small sizes (graft size, <20 mm) hemodynamic gradients develop more quickly (P = .0007). However, in the adult sizes (graft sizes 20 and 22 mm) 15% of the patients had stenosis after 1 year. The Journal of Thoracic and Cardiovascular Surgery 2004 128, 834-840DOI: (10.1016/j.jtcvs.2004.08.015) Copyright © 2004 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Conduit explanted after 12 months because of severe stenosis (elastic van Gieson staining 12.5×): transverse section through the distal anastomosis showing, from top to bottom, the normal native architecture of the pulmonary artery, the jugular vein graft, and, at the bottom, a thick neointima. Note the suture holes, with some surrounding foreign-body reaction confined to the arterial and venous walls, respectively. The Journal of Thoracic and Cardiovascular Surgery 2004 128, 834-840DOI: (10.1016/j.jtcvs.2004.08.015) Copyright © 2004 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Detail of the neointima in a conduit explanted after 12 months because of severe stenosis (elastic van Gieson staining 50×). The neointima is composed of uniformly distributed spindle cells, without neovascularization or inflammation. Concentrically oriented histiocytes surround the suture hole. The latter reaction is sharply demarcated from the neointima. The Journal of Thoracic and Cardiovascular Surgery 2004 128, 834-840DOI: (10.1016/j.jtcvs.2004.08.015) Copyright © 2004 The American Association for Thoracic Surgery Terms and Conditions