Abstract

Objective: To determine efficacy of use of a pedicled autologous pericardial flap when reconstructing the caval venous channel or the right ventricular outflow tract (RVOT).

Methods: Sixty patients underwent reconstruction of the RVOT, using a pedicled pericardial patch, for repairing tetralogy of Fallot in 36 including 15 with pulmonary atresia, common arterial trunk in 6, and other complicated malformations in 9, and also for the Ross procedure in 9. In another 4 undergoing the William's procedure for repairing the anomalously connected right upper pulmonary vein, a pedicled pericardial patch was similarly used for augmenting the SVC channel. In 9 patients, a pedicled autologous pericardial roll was used for extracardiac rerouting of the IVC drainage to establish total cavopulmonary connection.

Results: One patient with TF/PA died postoperatively because of endocarditis caused by MRSA through the central venous catheter. Autopsy demonstrated severe infection around the VSD patch of PTFE, but none at the RVOT of the pedicled autologous tissue. In 3 patients, the RVOT became markedly dilated within several months after repair. Reoperation was carried out in 2 of these, and the pedicled autologous pericardial flap proved to be alive and considerably thickened. In the other 69 patients, no obstruction, no dilatation, no calcification, nor thrombosis has been found in the reconstructed channel with the follow-up of 2 to 60 months.

Conclusion: The pedicled autologous pericardial flap can provide favourably the channels for the right heart, avoiding obstruction, thrombosis, and infection. It should be noted, however, that dilatation could occur for the RVOT.