Asian Cardiovasc Thorac Ann 2002;10:95-96
© 2002 Asia Publishing EXchange Pte Ltd
Closure of Bronchial Defects Using Glutaraldehyde-Treated Pericardium
Robert WM Frater, FRCS
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Department of Cardiothoracic Surgery Montefiore Medical Center and Albert Einstein College of Medicine 1575 Blondell Avenue, Suite 125 Montefiore Medical Park Bronx NY 10461, USA
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I enjoyed reading the paper by Dhaliwal and colleagues1 on closure of bronchial defects using glutaraldehyde-treated pericardium. I congratulate them on their experience and thoroughly agree with their conclusions. PG Rosario and I presented two similar cases to the American Thoracic Society in 1991.
The first case was an infant who had inhaled a screw at some time in the past. An otolaryngologist attempting to remove it from the left lower lobe, tore the membranous part of the left main bronchus from its origin to the take-off of the upper lobe. At emergency operation, we found a chronically destroyed left lower lobe containing the screw. The left lower lobe was removed, and the longitudinal tear in the left main bronchus was closed with fine interrupted sutures. Despite a careful technique, the bronchus was narrowed to the extent that the upper lobe could not expand. A patch of glutaraldehyde-tanned bovine pericardium was inserted so as to enlarge the full length of the bronchus, allowing easy expansion of the upper lobe. Recovery was uneventful, and follow-up over 3 years showed a well-expanded remaining lung on the left side.
The second case was a 60-year-old lady who had a right bronchopleural fistula for 5 years following a pneumonec-tomy for primary adenocarcinoma. Her surgeon performed 2 thoracoplasties without success: either pus drained from a cutaneous fistula or she experienced cough and fever until the fistula reopened. There was no evidence of recurrent cancer. The fistula was completely flush with the trachea and just under 1.5 cm wide; thus a trans-pericardial approach for closure of a residual stump was not feasible. The tissue around the fistula was desmoplastic in consistency. We elected to excise this dense tissue through a right-sided approach using jet ventilation. A fire occurred due to the combined use of electrocautery and jet ventilation (this was in effect an oxygen-fueled fire and the sound was like that made by a Bunsen burner). We solved this problem and finally exposed the open orifice where the right main bronchus had been. Airtight closure was achieved with a bovine pericardial patch anchored by multiple interrupted sutures. Plastic surgeons mobilized the latissimus dorsi to fill the residual space and cover the patch before the chest was closed. At a recent visit, the patient had been doing well for 9 years with no further complaints.
It was gratifying that the aldehyde-tanned pericardium provided such excellent biological repair material in our cases. Dhaliwal and colleagues1 used tanned autogenous pericardium and clearly this gave excellent results. In the two cases described above, this option might have been difficult because of the thinness of the tissue in the case of the infant and the considerable extra surgery that would have been needed to expose the pericardium in the second case. Today, I would use aldehyde-tanned bovine peri-cardium, but with a modern treatment to cap the residual aldehydes.2 I agree completely with the authors' conclusions.
REFERENCE
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Dhaliwal RS, Puri D, Sidhu KS. Closure of bronchial defects using glutaraldehyde-treated pericardium. Asian Cardiovasc Thorac Ann
2001;9:204–7.[Abstract/Free Full Text]
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Frater RWM, Seifter E, Liao K, Wasserman F. Anti-calcification, proendothelial, and antiinflammatory effect of postaldehyde polyol treatment of bioprosthetic material. In: Gabbay S, Wheatley DJ, editors. Advances in anticalcific and antidegenerative treatment of heart valve bioprostheses. Austin: Silent Partners, 1997:105–11.
