Bhuvnesh Kumar Aggarwal

Pulmonary Valve Reconstruction in Absent Pulmonary Valve Syndrome: A New Technique

Abstract Background: In patients with absent pulmonary valve syndrome, the relief of the pulmonary regurgitation at the time of primary repair improves both the early and late results. Though homograft and heterograft valves and conduits have been used for this purpose, both are not easily available and are known for late failure. Monocusp and bicuspid semilunar valves made out of pericardium have their own problems. Hence, a technique of reconstructing an autologous competent 3‐cusp valve from the native tissues was developed. Methods: Two posterolateral semilunar cusps were fashioned from the anterior wall of the main pulmonary artery. The anterior cusp was made from autologous pericardium stitched to the autologous pericardial patch used to widen the right ventricular outflow tract. Results: This method of reconstruction was used in two patients aged 9 and 22 years, respectively. Visual assessment and passive testing after reconstruction revealed well functioning neopulmonary valves in both patients. The second patient, who had an unevenful hospital course, showed only mild pulmonary regurgitation at 5 years postreconstruction. Conclusions: As 2 of the 3 cusps are fashioned from the pulmonary arterial wall as a pedicled graft, we believe that they will retain their viability and grow with the pulmonary artery. Simultaneous reduction in the size of the pulmonary arteries will relieve bronchial compression when present. The anterior pericardial cusp, even if it eventually shrivels up, is unlikely to produce serious hemodynamic derangements.

Right Heart Bypass for Inferior Vena Cava Tumor Thrombus Extending into Heart

Radical nephrectomy with en bloc inferior vena caval tumor thrombectomy improves survival in patients with renal cell carcinoma with a tumor thrombus extending into the inferior vena cava. Cardiopulmonary bypass with or without deep-hypothermic circulatory arrest is advocated when the tumor thrombus extends into the right heart chambers. Right heart bypass was used to remove such a tumor thrombus successfully for the first time in a patient with renal cell carcinoma.