[HSF] ASD patch

[Rwmfglycar at aol.com]

Dear Damlit,
I used untanned autologous pericardium from Jan 1962 to 1973,  glutaraldehyde 
tanned bovine pericardium from 1974 to 1998 and glutaraldehyde  tanned bovine 
pericardium with Propylene glycol post tanning aldehyde blocking  treatment 
from 1998 to 2003. (Note my conflict of interest: I am a holder of the  patent 
concerning this process; I have a plant in South Africa which  manufactures it 
for St Jude which markets it as St Jude pericardial patch with  EnCap). The 
major purpose of the posttanning treatment was to retard the  development of 
cacification in juveniles by blocking unlinked residual aldehyde  groups. It 
also has an antiinflammatory and detoxifying effect.
   I never saw a recurrent ASD. The patients were in a  practice  with close 
postoperative followup. However I did see  calcification in the regular 
aldehyde tanned atrial patch of a 3 yr old  with an atrioventricular defect who had 
a Carpentier chordal shortening as  a part of her first mitral repair and came 
to repeat surgery because of rupture  of the shortened chorda 2 yrs later. I 
also saw calcification in a regular  aldehyde tanned bovine patch which had 
been used at a patient's fourth  valve replacement to replace an incidentally 
damaged atrial septum; when  she came to her fifth  surgery 9 years later in her 
late 50's,  the patch had calcified. There have been no reports of 
calcification  in  the pericardial patches with EnCap.
    In your case with no superior rim it is not difficult to  bring the 
sutures though the full rhickness of the atrial wall being aware  of not narrowing 
the Sup Vena Cava orifice. It is certainly possible for you to  use untanned 
or briefly tanned autogenous pericardium although the  preparation of the 
glutaraldehyde is generally done better in a plant preparing  it for manufacture 
than it is in an operating room.
Yours 
Bob
     
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