Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 1967 Nov;22(6):497–509. doi: 10.1136/thx.22.6.497

The use of a cusp-bearing homograft patch to the outflow tract and pulmonary artery in Fallot's tetralogy and pulmonary valvular stenosis

Paul Marchand 1,2
PMCID: PMC471694  PMID: 6076505

Abstract

A technique is described for maintaining pulmonary valve competence whilst widening the hypoplastic pulmonary artery ring found invariably in Fallot's tetralogy and pulmonary valve stenosis. A homograft composed of the aortic cusps, a portion of ascending aorta, and the anterior mitral leaflet is used. One, two, or three cusps may be replaced or added by variations of technique. The right ventricular outflow tract and the pulmonary trunk are also widened. The operation is applicable to children, and adult homografts can be used. The ring should be widened to a circumference of from 6 to 8 cm. so as to prevent residual pressure gradients. One or two cusp replacements are favoured in the hope that growth will proceed because a continuous portion of natural pulmonary artery and ring remains untouched. An advantage of the technique is the small ventriculotomy required to excise the infundibular obstruction and close the ventricular septal defect. Four case histories are presented. Three patients have survived operation and are doing well. Up to six months post-operatively no serious pulmonary incompetence has developed.

Full text

PDF
497

Images in this article

498Image
on p.498
499Image
on p.499
500Image
on p.500
500Image
on p.500
502Image
on p.502
503Image
on p.503
503Image
on p.503
504Image
on p.504
505Image
on p.505
505Image
on p.505
506Image
on p.506
508Image
on p.508
509Image
on p.509
509Image
on p.509

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BARNARD C. N., SCHRIRE V. The surgical treatment of the tetralogy of Fallot. Thorax. 1961 Dec;16:346–355. doi: 10.1136/thx.16.4.346. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. BARRATT-BOYES B. G. HOMOGRAFT AORTIC VALVE REPLACEMENT IN AORTIC INCOMPETENCE AND STENOSIS. Thorax. 1964 Mar;19:131–150. doi: 10.1136/thx.19.2.131. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. BENDER H. W., AUSTEN W. G., EBERT P. A., GREENFIELD L. J., TSUNEKAWA T., MORROW A. G. Experimental pulmonic regurgitation. The magnitudes and acute hemodynamic effects of regurgitant flows associated with various anatomic lesions. J Thorac Cardiovasc Surg. 1963 Apr;45:451–459. [PubMed] [Google Scholar]
  4. BLOUNT S. G., Jr, McCORD M. C., MUELLER H., SWAN H. Isolated valvular pulmonic stenosis clinical and physiologic response to open valvuloplasty. Circulation. 1954 Aug;10(2):161–172. doi: 10.1161/01.cir.10.2.161. [DOI] [PubMed] [Google Scholar]
  5. Barratt-Boyes B. G., Lowe J. B., Cole D. S., Kelly D. T. Homograft valve replacement for aortic valve disease. Thorax. 1965 Nov;20(6):495–504. [PMC free article] [PubMed] [Google Scholar]
  6. COHEN M., LILLEHEI C. W., VARCO R. L., WARDEN H. E. Complete anatomical correction of the tetralogy of Fallot defects; report of a successful surgical case. AMA Arch Surg. 1956 Sep;73(3):526–531. doi: 10.1001/archsurg.1956.01280030152018. [DOI] [PubMed] [Google Scholar]
  7. DUPLESSIS L. A., MARCHAND P. THE ANATOMY OF THE MITRAL VALVE AND ITS ASSOCIATED STRUCTURES. Thorax. 1964 May;19:221–227. doi: 10.1136/thx.19.3.221. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. ELLISON R. G., BROWN W. J., Jr, HAGUE E. E., Jr, HAMILTON W. F. Physiologic observations in experimental pulmonary insufficiency. J Thorac Surg. 1955 Dec;30(6):633-40; discussion, 640-1. [PubMed] [Google Scholar]
  9. FOWLER N. O., DUCHESNE E. R. Effect of experimental pulmonary valvular insufficiency on the circulation. J Thorac Surg. 1958 May;35(5):643–650. [PubMed] [Google Scholar]
  10. Fuller D. N., Marchand P., Zion M. M., Zwi S. Homograft replacement of the pulmonary valve. Thorax. 1966 Jul;21(4):337–342. doi: 10.1136/thx.21.4.337. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. GERBODE F., KERTH W. J. TECHNICAL CONSIDERATIONS IN THE TREATMENT OF TETRALOGY OF FALLOT-THE TRANSVERSE VENTRICULOTOMY. Ann Surg. 1963 Dec;158:975–981. doi: 10.1097/00000658-196312000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. KIRKLIN J. W., PAYNE W. S., THEYE R. A., DUSHANE J. W. Factors affecting survival after open operation for tetralogy of Fallot. Ann Surg. 1960 Sep;152:485–493. [PMC free article] [PubMed] [Google Scholar]
  13. LILLEHEI C. W., LEVY M. J., ADAMS P., ANDERSON R. C. CORRECTIVE SURGERY FOR TETRALOGY OF FALLOT. LONG-TERM FOLLOW-UP BY POSTOPERATIVE RECATHETERIZATION IN 69 CASES AND CERTAIN SURGICAL CONSIDERATIONS. J Thorac Cardiovasc Surg. 1964 Oct;48:556–576. [PubMed] [Google Scholar]
  14. MURRAY G. Homologous aortic-valve-segment transplants as surgical treatment for aortic and mitral insufficiency. Angiology. 1956 Oct;7(5):466–471. doi: 10.1177/000331975600700509. [DOI] [PubMed] [Google Scholar]
  15. PRICE B. O. Isolated incompetence of the pulmonic valve. Circulation. 1961 Apr;23:596–602. doi: 10.1161/01.cir.23.4.596. [DOI] [PubMed] [Google Scholar]
  16. Ross D. N. Aortic valve surgery. Ann R Coll Surg Engl. 1966 Sep;39(3):192–197. [PMC free article] [PubMed] [Google Scholar]
  17. SABISTON D. C., Jr, CORNELL W. P., CRILEY J. M., NEILL C. A., ROSS R. S., BAHNSON H. T. THE DIAGNOSIS AND SURGICAL CORRECTION OF TOTAL OBSTRUCTION OF THE RIGHT VENTRICLE. AN ACQUIRED CONDITION DEVELOPING AFTER SYSTEMIC ARTERY--PULMONARY ARTERY ASASTOMOSIS FOR TETRALOGY OF FALLOT. J Thorac Cardiovasc Surg. 1964 Oct;48:577–587. [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES