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Currarino triad with dual pathology in the presacral mass: report of a case

Thambidorai CR, Muin I, Razman J, Zulfiqar A

Dis Colon Rectum, 2003 Jul;46(7):974-7.
PMID: 12847376

PURPOSE: Currarino triad, which comprises anorectal stenosis, anterior sacral defect, and a presacral mass, is an uncommon cause of constipation in children and adults. The presacral mass in this triad is most often caused by an anterior sacral meningocele, a teratoma, or an enterogenous cyst, but rarely may be caused by dual pathology. A neonate with Currarino triad and dual pathology in the presacral mass is described in this report.
METHOD: A male Chinese neonate, who presented with abdominal distention and constipation on the second day of life, was found to have features of Currarino triad. Colostomy was done in the neonatal period, and the presacral mass was excised by posterior sagittal perineal approach at the age of six months.
RESULTS: The excised presacral mass consisted of an anterior meningocele and a teratoma. The patient continued to have constipation during follow-up and required anorectoplasty to correct residual anorectal stenosis. At the time of this report the patient was three years old and growing normally with normal anorectal function.
DISCUSSION: Of a total of about 200 cases of complete Currarino triad found in the literature, in only 22 patients did the presacral mass contain both meningocele and teratoma. The features of these 22 patients and the current views on the surgical management of Currarino triad are discussed.

Matched MeSH terms: Constriction, Pathologic/complications; Constriction, Pathologic/surgery
Placement of removable metal biliary stent in post-orthotopic liver transplantation anastomotic stricture

Tee HP, James MW, Kaffes AJ

World J Gastroenterol, 2010 Jul 28;16(28):3597-600.
PMID: 20653071

Postoperative biliary strictures are the most common cause of benign biliary stricture in Western countries, secondary to either operative injury or bile duct anastomotic stricture following orthotopic liver transplantation (OLT). Surgery or endoscopic interventions are the mainstay of treatment for benign biliary strictures. We aim to report the outcome of 2 patients with refractory anastomotic biliary stricture post-OLT, who had successful temporary placement of a prototype removable covered self-expandable metal stent (RCSEMS). These 2 patients (both men, aged 44 and 53 years) were given temporary placement of a prototype RCSEMS (8.5 Fr gauge delivery system, 8 mm x 40 mm stent dimensions) in the common bile duct across the biliary stricture. There was no morbidity associated with stent placement and removal in these 2 cases. Clinical parameters improved after the RCSEMS placement. Long-term biliary patency was achieved in both the patients. No further biliary intervention was required within 14 and 18 mo follow-up after stent removal.

Matched MeSH terms: Constriction, Pathologic/etiology
Unusual presentation of pheochromocytoma with ischemic sigmoid colitis and stenosis

Tan F, Thai AC, Cheah WK, Mukherjee JJ

South. Med. J., 2009 Oct;102(10):1068-70.
PMID: 19738530 DOI: 10.1097/SMJ.0b013e3181b571e6

A 45-year-old woman with poorly controlled hypertension and diabetes mellitus presented with left iliac fossa pain, constipation alternating with diarrhea, and weight loss. She had been diagnosed with idiopathic cardiomyopathy five years previously. Echocardiogram had shown a left ventricular ejection fraction (LVEF) of 35%; coronary angiogram was normal. Colonoscopy revealed sigmoid colitis with stenosis. Abdominal computed tomography revealed a 5 cm right adrenal tumor. Twenty-four hour urinary free catecholamines and fractionated metanephrine excretion values were elevated, confirming pheochromocytoma. Her colitis resolved after one month of adrenergic blockade. Repeat echocardiogram showed improvement of LVEF to 65%. After laparoscopic right adrenalectomy, the patient's hypertension resolved, and diabetic control improved. Timely management avoided further morbidity and potential mortality in our patient.

Matched MeSH terms: Constriction, Pathologic/etiology; Constriction, Pathologic/therapy
MRI Markers of Mixed Pathology and Cognitive Impairment in Multiethnic Asians

Tan CH, Hilal S, Xu X, Vrooman H, Cheng CY, Wong TY, et al.

J Alzheimers Dis, 2020;73(4):1501-1509.
PMID: 31958085 DOI: 10.3233/JAD-190866

There is a need to elucidate the combined influence of neurodegeneration and cerebrovascular disease (CeVD) on cognitive impairment, especially in diverse populations. Here, we evaluated 840 multiethnic individuals (mean age = 70.18) across the disease spectrum from the Epidemiology of Dementia in Singapore study. First, we determined whether a validated quantitative MRI score of mixed pathology is associated with clinical diagnosis and whether the score differed between ethnicities (Chinese, Malays, and Indians). We then evaluated whether the score was associated with multidomain cognitive impairment and if additional measures of CeVD were further associated with cognitive impairment. We found that lower quantitative MRI scores were associated with severity of clinical diagnosis and Chinese individuals had the highest quantitative MRI scores, followed by Indians and Malays. Lower quantitative MRI scores were also associated with lower performance in attention, language, visuoconstruction, visuomotor, visual, and verbal memory domains. Lastly, the presence of intracranial stenosis and cortical cerebral microinfarcts, but not cerebral microbleeds, were associated with memory performance beyond quantitative MRI scores. Taken together, our results demonstrate the utility of using multiple MRI markers of neurodegeneration and CeVD for identifying multiethnic Asians with the greatest cognitive impairment due to mixed pathology.

Matched MeSH terms: Constriction, Pathologic
Fulltext A successful case of endovascular treatment (EVT) of anterior communicating artery aneurysm associated with moyamoya disease

Sobri, M.A., Noorakmal, A., Razali, R.

Malaysian Journal of Medicine and Health Sciences, 2012;8(1):73-76.
MyJurnal

Saccular aneurysms associated with moyamoya disease are commonly located in the vertebrobasilar circulation. Anterior circulation aneurysm associated with moyamoya disease is uncommon and is usually treated by neurosurgical clipping. Objective: We report a succesful treatment using the endovascular approach in a case of ruptured anterior communicating artery aneurysm in unilateral moyamoya disease. Clinical Presentation: A 23 year old man presented with a 5 day history of headache, diplopia and fever. Computed Tomography (CT) scan and cerebral angiogram showed a bilobed anterior comunicating artery aneurysm. There was also severe M1 segment stenosis of the left middle cerebral artery with multiple collaterals, representing moyamoya vessels. Intervention: Treatment was done under general anesthesia and followed the standard practice for endovascular treatment. The aneurysm was occluded with three detachable platinum microcoils (Microplex®, Microvention®). Conclusion: Endovascular treatment can be a treatment option for ruptured anterior circulation saccular aneurysms associated with moyamoya disease.

Matched MeSH terms: Constriction, Pathologic
Discovery of coarctation of the aorta following renal doppler sonography

Sidney Ong CL, Ch'ng LS, Aida Bt AA

Med J Malaysia, 2018 10;73(5):330-331.
PMID: 30350816 MyJurnal

Coarctation of the aorta (CoA) is present in 0.4% of live births and in 7% of patients with congenital heart disease. While there may be florid presentations of congestive heart failure in the neonatal period, the diagnosis during adulthood is often delayed. We encountered a 20-year-old woman who was discovered to be hypertensive on routine check-up. Following bilateral abnormal renal doppler sonography, MR angiogram revealed a short-segment stenosis of the descending thoracic aorta. Review of her chest radiograph showed a small aortic knuckle. This case highlights an unconventional algorithm in diagnosing aortic coarctation in adulthood.

Matched MeSH terms: Constriction, Pathologic
Fulltext CT findings of congenital neonatal pyriform aperture stenosis

Sidek HAB, Teh YG, Tangaperumal A, Zaki FM, Kew TY

Oxf Med Case Reports, 2021 May;2021(5):omab018.
PMID: 34055355 DOI: 10.1093/omcr/omab018

Congenital neonatal pyriform aperture stenosis (CNPAS) is a rare but potentially lethal condition that causes respiratory distress. The characteristic narrowing of the pyriform aperture along with other associated craniofacial dysmorphism is diagnosed using cross-sectional imaging such as computed tomography (CT) and magnetic resonance imaging. CT scan is the imaging of choice for confirming and characterizing CNPAS. Infants are obligate nasal breathers in the first 5 months of life. Hence, a high degree of clinical suspicion, prompt imaging diagnosis and adequate respiratory support is critical to help reduce the morbidity of this condition.

Matched MeSH terms: Constriction, Pathologic
Fulltext Hemodynamic effects resulting from a common carotid to middle cerebral bypass with varying degrees of proximal internal carotid stenosis

Sheau, Fung Sia, Yu, Zhang, Yi, Qian, Khairul Azmi Abd Kadir, Hazman Mohd Nor, Morgan, Michael Kerin

Neurology Asia, 2014;19(3):241-247.
MyJurnal

Objective: To investigate the degree of stenosis of the internal carotid artery required for continuous blood flow in an interposition vein bypass to the middle cerebral artery. Methods: Computational fluid dynamics techniques were used to investigate a case of common carotid to middle cerebral artery brain bypass with varying degrees of internal carotid artery stenosis. Blood flow patterns across the patient-specific brain bypass were evaluated. Results: Simulation found that for cross section stenosis of less than 60%, no flow occurred in the bypass graft. Further narrowing of the internal carotid artery increased flow linearly within the bypass graft. There was significant energy loss and pressure gradient difference between the proximal and distal anastomosis sites of the bypass.
Conclusion: Computational fluid dynamics helps us to quantify the flow distribution, wall shear stress and pressure gradient in brain bypass surgery. The angle of the distal anastomosis had no effect on hemodynamic indices, allowing this consideration to be ignored in modeling. This modeling technique is useful to estimate the required degree of stenosis in the artery that is to be occluded to ensure sustained flow in the bypass. This will be of importance where there is staged surgery with a time interval between the bypass and the definitive internal carotid artery occlusion.

Matched MeSH terms: Constriction, Pathologic
Fulltext Iatrogenic aspiration of custom-made keel: a case report

Sharouny H, Omar RB

Iran Red Crescent Med J, 2014 Dec;16(12):e17066.
PMID: 25763237 DOI: 10.5812/ircmj.17066

INTRODUCTION: Laryngeal stenosis has various causes and treatment options. Endoscopic resection of the stenotic part with CO2 laser is one of the treatment options of laryngotracheal stenosis. Keels are useful for preventing adhesion formation, restenosis and web formation, which may happen during the later stage. They can be put in place either via the endoscopic approach or through a micro thyroidotomy and are held in place with a heavy suture through cricothyroid and thyrohyoid membranes. They are left in place for two to four weeks, and then removed through the endoscopic approach under general anesthetics.
CASE PRESENTATION: We report on a case of anterior glottis stenosis with keel aspiration for two weeks, after endoscopic CO2 laser resection of the stenotic section and keel placement. The patient was admitted to our center, where bronchoscopy was performed and the keel was removed. A new custom-made silastic keel was properly placed in raw areas and fixed to the skin with suture through the cricothyroid and thyrohyoid membranes. The keel was removed three weeks later.
CONCLUSIONS: Endoscopic keel placement should be done with heavy suture through cricothyroid and thyrohyoid membranes. Surgeons should suture the keel to the anterior laryngeal wall with specially designed Lichtenberger's needle-carriers to prevent complications such as keel aspiration, adhesion formation and imposing a second trip under general anesthetics, which put the patient at increased risk. The false vocal cord microflaps, as biological keels and a relatively new method may replace silastic keel placement in the future.

Matched MeSH terms: Constriction, Pathologic
Fulltext The use of dental drill in removing entrapped finger by metal ring in emergency department

Shamsuddin SR, Hashim AA, Nazer B, Hashairi F, Shaik Farid AW, Abu Yazid MN

Med J Malaysia, 2012 Jun;67(3):349-50.
PMID: 23082436 MyJurnal

Ring removal is indicated in a number of clinical circumstances to manage or prevent tourniquet effect of the digit. A ring made from hardened metal may defy commonly known methods of removal. We reported a case of unusual difficulty in removing a ring of hardened metal composition using a dental drill. We believed the unusual circumstances of this case is likely to be repeated in some other clinical practice and this instrument is an appropriate option to consider in such cases.

Matched MeSH terms: Constriction, Pathologic/complications; Constriction, Pathologic/therapy
Fulltext Centromeres of Cucumis melo L. comprise Cmcent and two novel repeats, CmSat162 and CmSat189

Setiawan AB, Teo CH, Kikuchi S, Sassa H, Kato K, Koba T

PLoS One, 2020;15(1):e0227578.
PMID: 31945109 DOI: 10.1371/journal.pone.0227578

Centromeres are prerequisite for accurate segregation and are landmarks of primary constrictions of metaphase chromosomes in eukaryotes. In melon, high-copy-number satellite DNAs (SatDNAs) were found at various chromosomal locations such as centromeric, pericentromeric, and subtelomeric regions. In the present study, utilizing the published draft genome sequence of melon, two new SatDNAs (CmSat162 and CmSat189) of melon were identified and their chromosomal distributions were confirmed using fluorescence in situ hybridization. DNA probes prepared from these SatDNAs were successfully hybridized to melon somatic and meiotic chromosomes. CmSat162 was located on 12 pairs of melon chromosomes and co-localized with the centromeric repeat, Cmcent, at the centromeric regions. In contrast, CmSat189 was found to be located not only on centromeric regions but also on specific regions of the chromosomes, allowing the characterization of individual chromosomes of melon. It was also shown that these SatDNAs were transcribed in melon. These results suggest that CmSat162 and CmSat189 might have some functions at the centromeric regions.

Matched MeSH terms: Constriction
Familial congenital laryngotracheal stenosis: A systematic review

Saniasiaya J, van der Meer G, Toll EC, McCaffer C, Barber C, Neeff M

Int J Pediatr Otorhinolaryngol, 2024 Feb;177:111841.
PMID: 38181460 DOI: 10.1016/j.ijporl.2023.111841

BACKGROUND: Congenital laryngotracheal stenosis (CLS) is a rare cause of stridor among newborns. Evidence has shown that several family members can be affected by CLS. Knowledge of the pathophysiology of familial congenital laryngotracheal stenosis (FCLS) will enable more effective therapeutic strategies.
OBJECTIVE: To determine the clinical course and outcome of familial congenital laryngotracheal stenosis (FCLS).
METHODS: A literature search was conducted over a period of one month (September 2023) by searching several databases to identify studies published from inception to 31st August 2023.
RESULTS: Of 256 papers identified, five articles met the inclusion criteria. A total of 17 patients with slight female predominance (59 %) were identified. Familial congenital tracheal stenosis was reported in female twins (100 %). A variety of clinical presentations were listed. An endoscopic airway study was performed on all patients. 64.8 % of the included children were managed surgically. Genetic studies performed on 41 % of children could not locate genetic abnormalities.
CONCLUSION: Consanguinity, twin births, and female gender could be predisposing factors for FCLS, although the quality of evidence is low due to the rarity of the condition.

Matched MeSH terms: Constriction, Pathologic
Fulltext Antinociceptive Activity of Methanol Extract of Muntingia calabura Leaves and the Mechanisms of Action Involved

Sani MH, Zakaria ZA, Balan T, Teh LK, Salleh MZ

Evid Based Complement Alternat Med, 2012;2012:890361.
PMID: 22611437 DOI: 10.1155/2012/890361

Muntingia calabura L. (family Elaeocarpaceae) has been traditionally used to relieve various pain-related ailments. The present study aimed to determine the antinociceptive activity of methanol extract of M. calabura leaves (MEMC) and to elucidate the possible mechanism of antinociception involved. The in vivo chemicals (acetic acid-induced abdominal constriction and formalin-, capsaicin-, glutamate-, serotonin-induced paw licking test) and thermal (hot plate test) models of nociception were used to evaluate the extract antinociceptive activity. The extract (100, 250, and 500 mg/kg) was administered orally 60 min prior to subjection to the respective test. The results obtained demonstrated that MEMC produced significant (P < 0.05) antinociceptive response in all the chemical- and thermal-induced nociception models, which was reversed after pretreatment with 5 mg/kg naloxone, a non-selective opioid antagonist. Furthermore, pretreatment with L-arginine (a nitric oxide (NO) donor), N(G)-nitro-L-arginine methyl esters (L-NAME; an inhibitor of NO synthase (NOS)), methylene blue (MB; an inhibitor of cyclic-guanosine monophosphate (cGMP) pathway), or their combination also caused significant (P < 0.05) change in the intensity of the MEMC antinociception. In conclusion, the MEMC antinociceptive activity involves activation of the peripheral and central mechanisms, and modulation via, partly, the opioid receptors and NO/cGMP pathway.

Matched MeSH terms: Constriction
Cardamonin attenuates hyperalgesia and allodynia in a mouse model of chronic constriction injury-induced neuropathic pain: Possible involvement of the opioid system

Sambasevam Y, Omar Farouk AA, Tengku Mohamad TA, Sulaiman MR, Bharatham BH, Perimal EK

Eur J Pharmacol, 2017 Feb 05;796:32-38.
PMID: 27988285 DOI: 10.1016/j.ejphar.2016.12.020

Neuropathic pain arises from the injury of nervous system. The condition is extremely difficult to be treated due to the ineffectiveness and presence of various adverse effects of the currently available drugs. In the present study, we investigated the antiallodynic and antihyperlagesic properties of cardamonin, a naturally occurring chalcone in chronic constriction injury (CCI)-induced neuropathic pain mice model. Our findings showed that single and repeated dose of intra-peritoneal administration of cardamonin (3, 10, 30mg/kg) significantly inhibited (P<0.001) the chronic constriction injury-induced neuropathic pain using the Hargreaves plantar test, Randall-Selitto analgesiometer test, dynamic plantar anesthesiometer test and the cold plate test in comparison with the positive control drug used (amitriptyline hydrochloride, 20mg/kg, i.p.). Pre-treatment with naloxone hydrochloride (1mg/kg, i.p.) and naloxone methiodide (1mg/kg, s.c) significantly reversed the antiallodynic and antihyperalgesic effects of cardamonin in dynamic plantar anesthesiometer test and Hargreaves plantar test, respectively. In conclusion, the current findings demonstrated novel antiallodynic and antihyperalgesic effects of cardamonin through the activation of the opioidergic system both peripherally and centrally and may prove to be a potent lead compound for the development of neuropathic pain drugs in the future.

Matched MeSH terms: Constriction
Fulltext Feasibility of Unilateral Approach for Bilateral Decompressive Endoscopic Spinal Surgery for Lumbar Stenosis to Improve Back and Leg Pain: A Consecutive Single-Center Series of 60 Patients

Salim AA, Yusof AH, Johari J, Yusof MI

Front Surg, 2020;7:507954.
PMID: 33364252 DOI: 10.3389/fsurg.2020.507954

Introduction: Endoscopic surgery is one of the methods that achieve the goal of decompression while minimizing collateral tissue damage. Its efficacy and safety have been supported by numerous studies. There is a plethora of studies on lumbar stenosis regarding the outcomes and related issues in endoscopic spine surgery. However, few studies evaluated the outcome of the decompressive lumbar spine surgery. The present study aims to analyze the outcome of a unilateral approach to endoscopic surgery for lumbar stenosis using the visual analog scale (VAS), the Oswestry Disability Index (ODI), and MacNab's criteria. Methods: This is a retrospective study (level IV) conducted between January 2009 and December 2013 on 60 patients who underwent endoscopic interlaminar decompressive spine surgery (Destandau method) for lumbar degenerative spinal stenosis in the Hospital Universiti Sains Malaysia. The clinical outcome was measured pre-operatively and post-operatively for VAS: for back and leg pain, motor and sensory grading, the ODI, and MacNab's criteria. A paired t-test was used for statistical analysis. Results: The mean age of patients was 60.82 years comprising 23 males (38.3%) and 37 females (61.7%). The mean follow-up period was 30.1 months (range = 17.2-43 months). The mean operation time was 183.6 min (ranging from 124.8 to 242.4 min), and the mean blood loss was 150.18 mL (ranging from 30.82 to 269.54 mL). Post-operatively, mean hospital stay was 2.45 days (ranging from 1.34 to 3.56 days). The most frequently involved level was L4/L5 in 51 patients (52.6%), followed by L3/L4 in 19 patients (19.6%), L5/S1 in 24 patients (24.7%), and L2/L3 in three patients (3.1%). Improvement in the post-operative VAS for back and leg pain and the ODI for pre-operation and post-operation was statistically significant (p < 0.001). Conversely, the reduction in neurological status was statistically insignificant. Based on MacNab's criteria, 88.4% showed excellent to good outcomes. Conclusion: To summarize, unilateral percutaneous endoscopic spine surgery to achieve the bilateral decompression in lumbar stenosis provides excellent yet safe and effective outcomes. It improves back and leg pain and patients' function significantly.

Matched MeSH terms: Constriction, Pathologic
Internal auditory canal stenosis in congenital sensorineural hearing loss

Sakina MS, Goh BS, Abdullah A, Zulfiqar MA, Saim L

Int J Pediatr Otorhinolaryngol, 2006 Dec;70(12):2093-7.
PMID: 16996619

Sensorineural hearing loss (SNHL) due to internal auditory canal (IAC) stenosis with hypoplasia of the cochleovestibular nerve is a rare disorder. The diagnosis of the IAC stenosis requires both high resolution computed tomography scan (HRCT) and magnetic resonance imaging (MRI).

Matched MeSH terms: Constriction, Pathologic/diagnosis; Constriction, Pathologic/pathology; Constriction, Pathologic/physiopathology
Irreversible delayed complete heart block secondary to jailed first septal perforator following PCI of the left anterior descending coronary artery

Sadiq MA, Azman W, Abidin IZ

J Invasive Cardiol, 2012 Jan;24(1):E13-5.
PMID: 22210591

Permanent complete heart block (CHB) secondary to the loss of first septal perforator after percutaneous coronary intervention (PCI) of the left descending artery (LAD) is an extremely rare complication. We describe a case report where a patient underwent PCI of proximal LAD, complicated by loss of first septal perforator, septal infarction, and bifasicular block, which progressed to symptomatic delayed CHB. One week later, the patient required implantation of a permanent pacemaker following failure to wean off the transvenous temporary pacing maker.

Matched MeSH terms: Constriction, Pathologic/etiology
Fulltext Cerebral CT angiography and CT perfusion in acute stroke detection: a systematic review of diagnostic value

Sabarudin A, Subramaniam C, Sun Z

Quant Imaging Med Surg, 2014 Aug;4(4):282-90.
PMID: 25202664 DOI: 10.3978/j.issn.2223-4292.2014.07.10

The purpose of this study was to analyse the diagnostic value of cerebral CT angiography (CTA) and CT perfusion (CTP) examinations in the detection of acute stroke based on a systematic review of the current literature. The review was conducted based on searching of seven databases for articles published between 1993 and 2013. Diagnostic value in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy was analysed from 21 articles which were found to meet selection criteria. The mean sensitivity, specificity, PPV, NPV and accuracy for CTA were significantly higher than those for CTP with 83.2% (95% CI: 57.9-100.0%), 95.0% (95% CI: 74.4-100%), 84.1% (95% CI: 50.0-100%), 97.1 (95% CI: 94.0-100%) and 94.0% (95% CI: 83.0-99.0) versus 69.9% (95% CI: 20.0-97.0%), 87.4 (95% CI: 61.0-100.0%), 76.4% (95% CI: 48.0-95.4%), 78.2% (95% CI: 55.8-93.9%) and 89.8% (95% CI: 75.7-97.1%), respectively. This analysis shows that CTA has high diagnostic value in detecting high degree of cerebral arterial stenosis (>70%) whereas CTP provides high specificity in the detection of ischemia and infarct tissue of brain.

Matched MeSH terms: Constriction, Pathologic
Fulltext Coronary Artery Bypass Graft in a Young Adult, An Emerging Phenomenon: A Case Report.

Ramzisham, A.R.M., Joanna, O.S.M., Talal, A.R., Shahrulakmal, S., Maskon, O., Noorfaizan, S., et al.

International Medical Journal Malaysia, 2010;9(1):47-49.
MyJurnal

A 29-year-old, smoker, diabetic, hypertensive and hypercholesterolemic man was diagnosed of having severe coronary artery disease with a critical left main stem stenosis. On-pump coronary artery bypass graft surgery (CABG) was performed using conduits from the left internal mammary artery as well as the left radial artery and right saphenous vein which were both harvested endoscopically. He was discharged after a week of uneventful recovery. This case emphasizes on the best possible management of conduits selection, intraoperative myocardial protection and the risk factors modifi cation in achieving a long term graft patency and avoiding premature cardiac related death.

Matched MeSH terms: Constriction, Pathologic
Initial Clinical Trial of A Novel Pulmonary Valved Conduit

Prodan Z, Mroczek T, Sivalingam S, Bennink G, Asch FM, Cox M, et al.

Semin Thorac Cardiovasc Surg, 2021 May 10.
PMID: 33984478 DOI: 10.1053/j.semtcvs.2021.03.036

Valved allografts and xenografts for reconstruction of the right ventricular outflow tract (RVOT) lack durability and do not grow. We report the first clinical use of a completely bioabsorbable valved conduit (Xeltis pulmonary valve - XPV) in children. Twelve children (six male), median age five (two to twelve) years and median weight 17 (10 to 43) kg, underwent RVOT reconstruction with the XPV. Diagnoses were: pulmonary atresia with ventricular septal defect (VSD) (n=4), tetralogy of Fallot (n=4), common arterial trunk (n=3), and transposition of the great arteries with VSD and pulmonary stenosis (n=1). All had had previous surgery, including prior RVOT conduit implantation in six. Two diameters of conduit 16mm (n=5) and 18mm (n=7) were used. At 24 months none of the patients has required surgical re-intervention, 9 of the 12 are in NYHA functional class I and three patients in NYHA class II. None of the conduits has shown evidence of progressive stenosis, dilation or aneurysm formation. Residual peak gradient of >40 mm Hg was observed in three patients, caused by kinking of the conduit at implantation in 1 and distal stenosis in the peripheral pulmonary arteries in 2 patients. Five patients developed severe pulmonary valve insufficiency (PI); the most common mechanism was prolapse of at least one of the valve leaflets. The XPV conduit is a promising innovation for RVOT reconstruction. Progressive PI requires however an improved design (geometry, thickness) of the valve leaflets.

Matched MeSH terms: Constriction, Pathologic

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