Reconstituição da valva pulmonar e via de saída do ventrículo direito, com prótese bivalvular e prótese tubular valvada de tronco pulmonar de porco: estudo experimental e aplicação clínica

• Autor(a) principal: Maluf, Miguel Angel [UNIFESP]
• Data de Publicação: 1993
• Outros Autores: Verde, José L, Leal, João Carlos, Catani, Roberto [UNIFESP], Garcia Junior, Herminio Vega [UNIFESP], Thevenard, Rubens, Carvalho, Antonio Carlos [UNIFESP], Andrade, José L [UNIFESP], Andrade, José Carlos S [UNIFESP], Braile, Domingo Marcolino, Leao, Luiz Eduardo Villaca [UNIFESP], Buffolo, Enio [UNIFESP]
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: http://dx.doi.org/10.1590/S0102-76381993000100003; http://repositorio.unifesp.br/handle/11600/310
• topic: heart valves, pulmonary; heart valves prostheses; valva pulmonar; próteses valvulares cardíacas

Obstruction of the right ventricle outlet tract (RVOT) has been the object of arguments regarding its surgical correction, while there are different criteria for reconstruction. Thus two kinds of prostheses were developed from the pig pulmonary trunk (PT). 1) One with two valves of the pulmonary valve (PV), named bivalvular graft, and could be used for correction of Fallot with pulmonary ring hypoplasia. 2) The other, with a tubular form, containing the pig PV itself and named valved conduit, could be used in RVOT reconstruction for patients with pulmonary atresia (PA). These prostheses were tested in an experimental model: implant of the bivalvular graft was performed in 16 sheep with the aid of extracorporeal circulation (ECC). The surgical technique consisted of resection of the two valves of the PV and of the anterior wall of the infundibulum; this condition was similar to Fallot correction. Implant of the valvular conduit was carried out in 12 sheep, without ECC, by direct clamping of the RV infundibulum. The PT was then ligated, deviating blood flow through the conduit. Intraoperative hemodynamics and echodoppler evaluation of the bivalvular graft showed good PV competence and only 1 case of gradient higher than 10 mmHg. Because of frequent pulmonary hemorrhage followed by death due to ECC, this group was not evaluated in the postoperative period. Intraoperative hemodynamic measurements of the valvular conduit were carried out showing good valvular competence and gradient higher than 10 mmHg in 3 cases. There was no operative mortality. Seven sheeps were followed-up during the late postoperative period with a control echodoppler on days 99 and 135 of follow-up. Gradients ranged from 9.85 to 49 mmHg (mean = 19.7). Four sheep underwent hemodynamic studies at six months of follow-up. There was a slight increase in the gradient between RV and PT (mean = 22.3 mmHg), no gradient being observed inside the conduit. Anatomopathological evaluation was performed. Clinical applications of the bivalvular prostheses was performed in 3 patients with tetralogy of Fallot and hypoplasia of the pulmonary ring (2 cases) and PV absent (1 case); they were 16,2 and 7 years old. The postoperative echodopplercardiogram showed gradients between 10 to 20 mmHg and mild pulmonary valve insufficiency. Clinical application of the valvular conduit was performed in 2 patients: 1 with pulmonary atresia and ventricular septal defect (VSD), the other with corrected transposition of the great arteries, VSD and subpulmonary stenosis (10 and 6 years old, respectively). The postoperative echodopplercardiogram showed gradients between 15 to 18 mmHg. Although the results of the experiment may be considered acceptable, reconstruction of the RVOT with the newly developed prostheses, obviously requires to be tested over time to better evaluate their resistance to calcification, infection, obstruction and rupture.