Unexpected Internalization of a Pulmonary Artery Band in a Porcine Model of Tetralogy of Fallot

Abstract

Background:

We report our experience of an unexpected complication of internalization of a pulmonary artery (PA) band in the vascular lumen, which occurred in a chronic porcine model of repaired tetralogy of Fallot (TOF).

Methods:

Twelve piglets were divided into 3 groups: (1) TOF model animals (PA band plus pulmonary valvotomy, n = 4), (2) pulmonary insufficiency (PI) animals (pulmonary valvotomy, n = 4), and (3) control animals (n = 4). A nonabsorbable, coated braided polyester tape was used to perform the main pulmonary artery banding. Echocardiography was performed 4 months postoperatively. After each animal was euthanized, PA histological analysis was performed in animals with band internalization.

Results:

Significant postsurgical pulmonary regurgitation and right ventricular enlargement were present in the TOF and PI, compared with control animals, whereas no significant pulmonary stenosis was observed in TOF animals when compared with PI group. Postmortem examination of all TOF animals revealed the constricting band to be intact but partially internalized into the PA lumen, allowing blood flow around the stenosis. Histological sections of the banded PA in the area of internalization showed a significant disorganization of the medial layer, with significant scarring and fibrotic reaction surrounding the outside of the band and the presence of inflammatory cells suggesting a significant inflammatory response during band internalization.

Conclusions:

Band internalization may occur after PA banding using a nonabsorbable, coated braided polyester tape in a chronic porcine model of repaired TOF. This unusual complication was likely due to the type of material used for banding.

Keywords

tetralogy of Fallot banding erosion animal model

Get full access to this article

View all access options for this article.

References

Bolger

Coats

Gatzoulis

. Congenital heart disease: the original heart failure syndrome. Eur Heart J. 2003;24(10):970–976.

Nollert

Fischlein

Bouterwek

Böhmer

Klinner

Reichart

. Long-term survival in patients with repair of tetralogy of Fallot: 36-year follow-up of 490 survivors of the first year after surgical repair. J Am Coll Cardiol.1997;30(5):1374–1383.

Cuypers

Menting

Konings

. Unnatural history of tetralogy of Fallot: prospective follow-up of 40 years after surgical correction. Circulation. 2014;130(22):1944–1953.

Thambo

Roubertie

De Guillebon

. Validation of an animal model of right ventricular dysfunction and right bundle branch block to create close physiology to postoperative tetralogy of Fallot. Int J Cardiol. 2012;154(1):38–42.

Thambo

Dos Santos

De Guillebon

. Biventricular stimulation improves right and left ventricular function after tetralogy of Fallot repair: acute animal and clinical studies. Heart Rhythm. 2010;7(3):344–350.

Charron

Roubertie

Benoist

. Identification of region-specific myocardial gene expression patterns in a chronic swine model of repaired tetralogy of Fallot. PLoS One. 2015;10(8):e0134146.

Chaturvedi

Redington

. Pulmonary regurgitation in congenital heart disease. Heart. 2007;93(7):880–889.

Takayama

Sekiguchi

Chikada

Noma

Ishizawa

Takamoto

. Mortality of pulmonary artery banding in the current era: recent mortality of PA banding. Ann Thorac Surg. 2002;74(4):1219–23.

Schmidt-Habelmann

Sivening

. Erfahrungen mit der bandelung der pulmonal-arterie. Thoraxchirurgie. 1966;14:541–545.

10.

Rohmer

Brom

Nauta

. Bands inside the pulmonary artery. A complication of the Dammann-Muller procedure. Ann Thorac Surg. 1967;3(5):449–454.

11.

Idriss

Riker

Paul

. Banding of the pulmonary artery: a palliative surgical procedure. J Pediatr Surg.1968;3(4):465–474.

12.

Verel

Taylor

Emery

. Failure of pulmonary artery banding due to migration of the band. Thorax. 1970;25(1):126–128.

13.

Hunt

Formanek

Levine

Castaneda

Moiler

. Banding of the pulmonary artery. Results in 111 children. Circulation.1971;43(3):395–406.

14.

Menahem

Venables

. Pulmonary artery banding in isolated or complicated ventricular septal defects. Results and effects on growth. Br Heart J. 1972;34(1):87–94.

15.

Mahle

Nicoloff

Knight

Moller

. Pulmonary artery banding: long-term results in 63 patients. Ann Thorac Surg.1979;27(3):216–224.

16.

Kutsche

Alexander

Van Mierop

. Hemolytic anemia secondary to erosion of a Silastic band into the lumen of the pulmonary trunk. Am J Cardiol. 1985;55(11):1438–1439.

17.

Danilowicz

Presti

Colvin

. The disappearing pulmonary artery band. Pediatr Cardiol. 1990;11(1):47–49.

18.

Stark

Berry

Silove

.The evaluation of materials used for pulmonary artery banding. Experimental study in piglets. Ann Thorac Surg. 1971;13(2):163–169.

19.

Lygate

Schneider

Hulbert

. Serial high resolution 3D-MRI after aortic banding in mice: band internalization is a source of variability in the hypertrophic response. Basic Res Cardiol. 2006;101(1):8–16.

20.

Zeltser

Gaynor

Petko

. The roles of chronic pressure and volume overload states in induction of arrhythmias: an animal model of physiologic sequelae after repair of tetralogy of Fallot. J Thorac Cardiovasc Surg. 2005;130(6):1542–1548.

21.

Lambert

Capderou

Le Bret

. Right ventricular failure secondary to chronic overload in congenital heart disease: an experimental model for therapeutic innovation. J Thorac Cardiovasc Surg. 2010;139(5):1197–1204.

22.

Bove

Vandekerckhove

Bouchez

Wouters

Somers

Van Nooten

. Role of myocardial hypertrophy on acute and chronic right ventricular performance in relation to chronic volume overload in a porcine model: relevance for the surgical management of tetralogy of Fallot. J Thorac Cardiovasc Surg. 2014;147(6):1956–1965.

23.

Lambert

Gouadon

Capderou

. Right ventricular failure secondary to chronic overload in congenital heart diseases: benefits of cell therapy using human embryonic stem cell-derived cardiac progenitors. J Thorac Cardiovasc Surg. 2015;149(3):708–715.

24.

Prêtre

Rosser

Mueller

Kretschmar

Dave

. Recycling of the pulmonary valve: an elegant solution for secondary pulmonary regurgitation in patients with tetralogy of Fallot. Ann Thorac Surg. 2012;94(3):850–852.