Correspondence

Long-Term Histologic Findings in Pulmonary Arteries Reconstructed with Autologous Pericardium

N Engl J Med 2003; 348:865-867February 27, 2003

Article

To the Editor:

Autologous pericardium has been used for angioplasty in pediatric cardiovascular surgery with good results, except in the case of the pulmonary valve.1 However, we know of no report on the histology of implanted autologous pericardium. We describe here the histology at three years of pulmonary arteries reconstructed with the use of autologous pericardium.

Patient 1, a seven-year-old girl whose right ventricle had a double outlet and who had pulmonary atresia, had undergone pulmonary-artery angioplasty with the use of autologous pericardium three years earlier, at the age of four. Angiography performed at seven years of age revealed sufficient development of the pulmonary artery, and a total-cavopulmonary-connection procedure was performed.

Patient 2, a seven-year-old girl with tetralogy of Fallot and pulmonary stenosis, had undergone a closure of the ventricular septal defect and pulmonary-artery angioplasty with the use of autologous pericardium at four years of age. Since angiography performed three years later revealed stenosis of the first branch of the left pulmonary artery and dilatation of the main pulmonary artery, pulmonary-artery angioplasty was performed.

The reconstructed tissue was examined after the operation in each case and was compared with native pericardium (Figure 1Figure 1The Histology of a Pulmonary Artery Reconstructed with the Use of Autologous Pericardium, as Compared with the Histology of Native Pericardium.). Staining with hematoxylin and eosin revealed a component of the tissue that resembled not the native pericardium but rather the native pulmonary artery. Although staining for smooth-muscle α-actin showed a layer of smooth-muscle cells in both cases, no clear layer was found in the native pericardium. Staining for factor VIII, CD34, and CD31 showed positive cells that confirmed the presence of a single layer of endothelial cells in both cases, but there was no such single layer of positive cells in the native pericardium. Our results indicate that the autologous pericardium differentiated to resemble the tissue of the pulmonary artery after it was used for pulmonary-artery angioplasty.

The mechanism of the transition of the transplanted autologous pericardium to the pulmonary artery is unclear. It has been reported that the important factors for construction of the vascular wall are the proliferation and differentiation of stem cells and the environment of the vascular wall as it synthesizes various cytokines actively and continuously.2-4 On the basis of our findings, we suggest that autologous pericardium could differentiate into vascular wall because of the effect of stem cells and the surrounding environment.

Narutoshi Hibino, M.D.
Toshiharu Shin'oka, M.D.
Hiromi Kurosawa, M.D.
Tokyo Women's Medical University, Tokyo 162-8666, Japan
shibino@hij.twmu.ac.jp

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   Kazuro L. Fujimoto, Jianjun Guan, Hideki Oshima, Tetsuro Sakai, William R. Wagner. (2007) In Vivo Evaluation of a Porous, Elastic, Biodegradable Patch for Reconstructive Cardiac Procedures. The Annals of Thoracic Surgery 83:2, 648-654
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   Marco Pocar, Emmanuel Villa, Alexandra Degandt, Philippe Mauriat, Philippe Pouard, Pascal R. Vouhé. (2005) Long-Term Results After Primary One-Stage Repair of Transposition of the Great Arteries and Aortic Arch Obstruction. Journal of the American College of Cardiology 46:7, 1331-1338
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