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Updated: Jun 6, 2026
Chronic Thromboembolic Pulmonary Hypertension and Assessment of Right Ventricular Function in the Piglet
Published on: November 4, 2015
Dysfunction of the pulmonary homograft used in the reconstruction of the right ventricle exit tract
Andréa Weirich Lenzi1, Márcia Olandoski, Wanderley Saviolo Ferreira
1Hospital Pequeno Príncipe, Pontificia Universidade Católica Paraná, Curitiba, PR, Brazil. andreawlenzi@yahoo.com.br
Insights
Pulmonary homografts smaller than 21 mm and inadequate valve size for patient age/weight increase the risk of dysfunction in congenital heart defect repair. These factors are critical for prosthesis failure in children.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomedical Engineering
Background:
- Pulmonary homografts are utilized for congenital heart defect repair involving right ventricle outflow tract obstruction.
- Long-term outcomes with pulmonary homografts have shown limited success.
Purpose of the Study:
- To identify risk factors associated with pulmonary homograft dysfunction and failure.
- To improve surgical outcomes for congenital cardiopathies.
Main Methods:
- A study involving pediatric patients undergoing right ventricle outflow tract enlargement using pulmonary homografts.
- Analysis of clinical, surgical, evolutional, and morphological variables as potential risk factors.
Main Results:
- Out of 75 patients, 13 (17.0%) experienced homograft dysfunction (stenosis or severe pulmonary insufficiency) at a median of 45 ± 20 months post-implantation.
- Risk factors for dysfunction included homograft size < 21 mm and pulmonary valve Z-scores < 0 or > 3.
Conclusions:
- Pulmonary homograft size < 21 mm is a determining factor for prosthesis dysfunction.
- Inadequate pulmonary valve size relative to patient age and weight significantly contributes to homograft failure.
Background:
The pulmonary homograft has been used as an option in the correction of congenital cardiopathy with obstruction of the right ventricle exit tract. The long term results, however, are little satisfactory.
Objective:
Identify the risk factors associated to the dysfunction and the pulmonary homograft failure.
Methods:
Study with children submitted to the enlargement of the exit tract of the right ventricle with pulmonary homograft. The clinical, surgical, evolutional and morphological aspects of the prosthesis variables were analyzed as risk factors.
Results:
The final sample of 75 patients with median age at the surgery of 22 months, varying from 1-157 months, presented 13 patients (17.0%) who developed dysfunction of the homograft, characterized by stenosis or severe pulmonary insufficiency. The occurrence time between the homograft implant and the detection of the dysfunction was of 45 ± 20 months. When the size of the homograft was smaller than 21 mm and the Z score of the pulmonary valva is lower than zero, or higher than three, the risk factors were considered for the dysfunction occurrence.
Conclusion:
The pulmonary homograft smaller than 21 mm and the inadequate pulmonary valva for the age and weight of the patient are determining factors for the prosthesis dysfunction.
