The use of pericardium in acquired heart disease: a review article.

Pericardium is an excellent material for reconstruction of the heart during the surgical management of certain acquired heart defects. This review details our experience with pericardium as a patch material for various parts of the left ventricle. MITRAL ANNULUS: Extensive calcification of the mitral annulus, abscess, multiple previous mitral valve replacements and rupture of the posterior wall of the left ventricle are challenging surgical problems that can be satisfactorily managed by reconstructing the mitral annulus with either fresh autologous or glutaraldehyde-fixed bovine pericardium. The mitral valve prosthesis is secured to the newly reconstructed mitral annulus. This procedure has proven to be durable and has provided very good long-term results. LEFT VENTRICULAR OUTFLOW TRACT: We have used bovine pericardium to enlarge the aortic annulus in patients with small aortic annulus undergoing aortic valve replacement with bioprosthetic valves. Patch enlargement of the aortic annulus probably increases the operative mortality of aortic valve replacement but it may favorably effect the clinical outcome and late survival. Another problem in the aortic root that frequently requires reconstruction with pericardium is aortic root abscess. We believe that radical resection of the abscess is the single most important component to eradicate infection in these patients. Pericardium is an excellent material to reconstruct all parts of the left ventricular outflow tract and the results have been excellent. RECONSTRUCTION OF THE LEFT VENTRICULAR WALL: We have also used pericardium to repair the left ventricle in patients with postinfarction ventricular septal defect. We have used a technique of infarct exclusion by suturing a properly tailored bovine pericardium to the endocardium of the left ventricle all around the infarct, excluding the left ventricular cavity from the infarcted wall. This technique has improved the outcome of surgery for this mechanical complication of myocardial infarction, particularly in patients with posterior interventricular septal rupture.