A Simple Method of Truncal Valve Reconstruction in Children

This video describes a simple method of complete reconstruction of a truncal valve using equine pericardium in a one-year-old patient with severe truncal valve regurgitation.

Surgical Technique

Through a transverse aortotomy, the truncal valve was excised, leaving a 2 mm margin of leaflet tissue in order to preserve the native valvar hinge joint.

A rectangular glutaraldehyde-free equine pericardial patch (Matrix Patch, Auto Tissue Berlin GmbH, Berlin, Germany) was used with the following dimensions: patch width equal to the diameter of the truncal annulus, and patch length equal to 4.5 times the diameter. Two transverse lines were drawn across this long rectangular patch such that it was divided into three equal parts (1).

A pericardial cylinder was constructed by suturing the two short edges of the patch to each other with a continuous suture.

This cylinder was sutured to the narrow native truncal valvar tissue that had been left in situ. Thus, this suture line does not form the hinge joint of the valve, theoretically reducing the risk that the suture will break due to fatigue. Suturing was started at the level of the three nadirs, progressing slightly more on the patch in order to give some volume to the reconstructed leaflets and to allow for growth of the annulus.

The height of the cylinder was inspected, and three stay stitches were placed on its free edge at sites where the commissures were to be reconstructed. These should be evenly spaced, without obstructing the coronary arteries.

The new commissures were constructed, suturing the patch to the truncal wall along three vertical lines at the marked sites, each with a double 5/0 polypropylene suture.

Conclusion

Reconstruction of the truncal valve with pericardium is a surgical option in children with reasonable early and midterm outcome. The authors do not have long-term experience with equine pericardial patch, but its flexibility may offer an advantage over bovine pericardium.

Fixed autologous pericardium may also be used instead of equine pericardium, but this may not be available in patients who have undergone previous operations.

This reconstruction is limited by calcification of the patch material in the long run, although the rate of calcification may vary depending on which type of patch is used.

Reference

1. Hosseinpour AR, Adsuar-Gómez A, González-Calle A, et al. Follow-up of a simple method for aortic valve reconstruction with fixed pericardium in children. Interact Cardiovasc Thorac Surg. 2017;25(6):983-984.