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An 83-year-old man presented 4 years after right carotid endarterectomy (CEA) with an infection of his prosthetic Dacron patch. Initial scans (CT angiogram and whole body labelled white cell scan) were clear with no infection or collection noted. Systemically, the patient presented well with no recorded fevers. With an occluded left internal carotid artery and severely stenosed vertebral arteries, surgery presented a high risk of major stroke due to the lack collateral supply and this was discussed extensively. The patient subsequently declined surgical management, and he was monitored closely on an outpatient basis. He presented again a year later with ongoing haemoserous ooze from the CEA site. Subsequently a two-stage procedure was performed, where initially a stent was inserted, followed by patch excision and debridement. A muscle flap was then mobilised over the opening. This new approach to carotid patch infections should gain traction over time as a safer alternative for high-risk patients.

Ventricular septal defect closure with a fenestrated patch is a recognized rescue maneuver to decrease the risk of right ventricular failure after complete repair in patients with pulmonary atresia. If the fenestration needs surgical closure, severe calcification of the patch may make it extremely difficult. We describe the closure of such a defect in a 6-year-old boy, using a double Dacron patch sandwich.

A 2.5-month-old female patient presented for closure of a ventricular septal defect (VSD). Transthoracic echocardiography showed a large muscular ventricular septal defect. After perventricular closure of the defect was performed with an Amplatzer muscular VSD occluder, peroperative transesophageal echocardiography revealed that the device had been implanted in the wrong area of the ventricular septum. The device was retrieved and a large mid-muscular defect with extension to the outlet septum was closed with a patch of Dacron which was secured with 5-0 sutures. A perforation in the ventricular septum due to attempted perventricular device delivery was seen, and it was repaired primarily. In the eighth month of follow-up, transthoracic echocardiography revealed an aneurysm in the posterior wall of the left ventricle. The patient’s electrocardiogram showed pathological Q waves and ST-segment elevation in leads DII, DIII, and aVF consistent with subacute inferior myocardial infarction. At subsequent surgery, this was found to be a true aneurysm, located in area of distribution of the obtuse marginal branch of the left circumflex coronary artery in the posterior wall of the left ventricle. The aneurysm was closed off using a Dacron patch, and the sac was resected. Development of a true aneurysm is a rare but important complication of attempted perventricular VSD closure.

A 67-year-old man was admitted with severe back pain and bilateral lower limb swelling. Enhanced computed tomography showed an infrarenal abdominal aortic aneurysm (92 × 75 mm2) and a short aortocaval fistula (7 mm). Immediately afterward, circulatory collapse occurred, and the patient was rushed to the operating theater. A much larger aortocaval fistula (22 × 35 mm2) than that demonstrated by preoperative computed tomography was found and was repaired with a Dacron patch while using two balloon-tipped catheters to control bleeding. Then, the abdominal aortic aneurysm was replaced with a bifurcated graft. The patient’s postoperative course was uneventful. In this case, enhanced computed tomography detected the aortocaval fistula, but could not assess its size accurately. Successful surgical repair of an aortocaval fistula depends on early accurate delineation of the fistula and prompt control of bleeding.

Three patients requested explantation of their saline-filled breast implants. Bilateral calcification had occurred in all six implants. Four of the implants were manufactured by McGhan Corporation (Santa Barbara, Calif.), and two, by the Simaplast Company (Toulon, France). All implants had been inserted in the subglandular plane and had been in place for 7 to 23 years. At the time of explantation, patients were 32, 34, and 44 years old. Calcification on the surface of the implants and capsules was analyzed. Implant surface calcification was clinically evident on all six implants, appearing as ivory-colored, tenaciously adherent deposits, only on the anterior surface of the implant. Capsular calcification, which was observed only microscopically, was characterized by poorly organized, irregularly shaped, calcified agglomerates; this calcification also occurred only on the anterior surface of the capsule, adjacent to the area of calcification on the implant. Ultrastructural analysis of scrapings from the implant surface showed large, electron-dense aggregates of crystals, with individual crystals measuring approximately 40 x 10 x 10 nm. In contrast, capsular calcification was characterized by two patterns of deposition, spherulitic aggregates of needle-shaped crystals and areas of metaplastic bone. The individual crystals were approximately 40 x 10 x 10 nm. Energy-dispersive x-ray spectroscopy of specimens from the areas of calcification on the implant and capsule surfaces demonstrated calcium and phosphorus. Electron diffraction of crystals from the implant and capsule surfaces demonstrated the D-spacings characteristic of calcium apatite. There were many differences between the calcification properties of these six saline implants and those of silicone gel implants. For example, mineralization has not been observed on the surface of gel implants, but in these saline implants it occurred primarily on the implant surface. Also, capsular calcification has been observed clinically in gel implants across the surface of the capsule (except at the site of attachment of a Dacron patch), but in this study it was observed only microscopically and was located on the anterior surface of the capsule, adjacent to the area of calcification on the implant. In addition, crystals 100 times larger than those observed on the six saline implant capsules have been observed on the surface of gel implant capsules. A model is presented to explain the mechanism of calcification associated with breast implants and to explain the observed differences between saline-filled and gel-filled implants.

A 41-year-old man with tetralogy of Fallot and dextrocardia, coronary sinus atrial septal defect and partially unroofed coronary sinus with persistent left superior vena cava (PLSVC) underwent a total correction of these anomalies. An association between these specific anomalies has not been reported previously in the literature. These defects were successfully corrected by a) closure of the coronary sinus atrial septal defect with PLSVC entering the right atrium using a pericardial graft; and b) ventricular partition with a Dacron patch and conotruncal repair for tetralogy of Fallot. The postoperative course of this patient has been uneventful.

Background: The current study investigated the effect of verapamil on the development of intimal hyperplasia (IH) using a sheep model. Methods: A gelatin-sealed Dacron patch graft was implanted into the left common carotid artery in 40 adult Merino sheep. Sheep were then randomly allocated to four groups. Group 1 were controls given no treatment (n = 10). Groups 2–4 were treated with intravenous verapamil 0.5 mg/kg per day in two divided doses for different lengths of time. Group 2 (n = 10) received treatment for 1 week; group 3 (n = 10) received treatment for 2 weeks and group 4 (n = 10) received treatment for 4 weeks. All sheep were killed at 4 weeks and the grafted segments of artery were harvested for IH assessment by an image analysis system. Results: The IH index from the three groups treated with verapamil was significantly less than that of the control (group 1, 0.287 ± 0.077; group 2, 0.205 ± 0.064, P < 0.05; group 3, 0.193 ± 0.059, P < 0.01; group 4, 0.171 ± 0.046, P < 0.01). Conclusion: The present study suggests that verapamil inhibits the development of IH even when treatment is given for only 1 week.

From January 1981 to June 1994, 17 patients underwent aortic annulus enlargement by a modified Manouguian's technique. A small aortic root associated with stenotic lesions was the main indication. The ages of the patients ranged from 5 to 55 years (mean, 21 ± 14 years). There were 10 males and 7 females. Four had concomitant mitral valve replacement, 2 had open mitral valvotomy, 1 underwent ventricular septal defect closure, excision of a subaortic membrane, and ascending aortic replacement. The aortic roots were enlarged to between 20 to 30 mm. A Dacron patch was used in 16 patients and glutaraldehyde-treated autologous pericardium was used in 1. Two patients (12%) died in the postoperative period, 1 due to hemorrhage and the other due to septicemia. Mitral regurgitation (grade 1) was seen in 1 patient postoperatively but there was no further deterioration on serial evaluation. Four patients were lost to follow-up. Of the 11 followed up over a period of 10 years, 7 were in New York Heart Association functional class I and 4 were in class II.

Congenital aneurysm of the sinus of Valsalva is a rare cardiovascular anomaly. It is usually silent until rupture occurs. The natural history of unruptured aneurysm of the sinus of Valsalva is still not clear, and the therapeutic strategy is uncertain. Here we reported a case of unruptured aneurysm of the sinus of Valsalva which was correctly diagnosed before invasive diagnostic procedures. A 30-year-old female noted mild palpitation and dyspnea for 1 month. Physically, a grade 3/6 systolic ejection murmur at upper left sternal border was detected. Echocardiography revealed dilatation and irregular protrusion of the right sinus of Valsalva encroaching on right ventricular outflow tract to cause obstruction. With these findings, unruptured aneurysm of the sinus of Valsalva with pulmonary stenosis was diagnosed. Cardiac catheterization and angiography confirmed the diagnosis. The aneurysm was repaired with a Dacron patch with good results. It is concluded that sinus of Valsalva aneurysm can be diagnosed by echocardiography before its rupture so as to render a proper management for this potentially life-threatening anomaly. Cathet. Cardiovasc. Intervent. 46:210–213, 1999. © 1999 Wiley-Liss, Inc.

The authors report 4 atherosclerotic extracranial carotid aneurysms (AECA) in 3 patients who had carotid endarterectomies with Dacron patch angioplasty (CEADP). This complication has not previously been reported with this patch material in this location. These AECAs were found in a group of 204 patients. Two hundred thirty-two arteries (1.7%) who had CEADP and who returned for regular follow-up from 3 months to 15 years postoperatively. Three aneurysms were excised after angiographic confirmation and replaced with autologous saphenous vein interposition grafts uneventfully. One of the three patients who had bilateral CEADP has since developed a contralateral aneurysm presumed to be an AECA but has refused angiography and surgery. This aneurysm remained essentially unchanged for two years after detection. The patient was then lost to follow-up. The diagnosis of AECA in the patients who were operated on was confirmed by histology. Dacron patch angioplasty as an adjunct to carotid endarterectomy is an accepted technique which yields satisfactory results. This report however, cautions about a significant complication which occurs late in the postoperative course of patients who have had this procedure.

Surgical atrial septal defect closure with a patch is one of the simplest interventions in cardiac surgery. However, patch infection could be a serious complication. A 34-year-old man was referred to our service 7 years after surgical closure with a Dacron patch of an ostium primum septal defect and mitral cleft closure. …

A wide range of host reactions can be produced in response to prosthetic breast implants. Although the spectrum of histological changes is well described in the literature, the chronology and relative occurrence of these changes are not well documented. Examination of 161 capsulectomy specimens from 84 women suggested the following chronological sequence of tissue response: fibrous scar tissue; histiocyte response; foreign body giant cell reaction to extruded or exposed material including polyurethane and Dacron patch; synovial-like metaplasia; and calcification. Fibrous scar tissue was seen in all implants. Histiocytic response was noted in 107/161 of the specimens and a foreign body giant cell reaction to polyurethane was seen only in the two Meme implants. Synovial-like metaplasia was less common than previously reported, occurring in 45/161 of specimens after a mean in situ duration of 11.7 years. This peculiar process was seen only in association with a prominent histiocytic response and was not associated with calcification. Dystrophic calcification, which has been reported as occurring rarely in implant capsules, was seen in 15/161 of our specimens after a mean in situ duration of 17.7 years.

Aortic coarctation (CoA) is the fifth most common congenital heart defect, accounting for 6% to 8% of live births with congenital heart disease. Traditional treatment for CoA consists of open surgical repair, and the endovascular procedures have been proposed as an alternative treatment. We describe the case of a 50-year-old man presented to our department with mild lower limbs claudication and hypertension. The computed tomography scan diagnosed an aortic postductal coarctation, which we treated with aortoplasty with Dacron patch. The open surgery, in our opinion, is nowadays still preferable due to the time-stable and effective outcome.

Background: In this study, we compared the short- and mid-term clinical and transthoracic echocardiographic results of bovine pericardial and Dacron patch materials used in repair of intracardiac defects. Methods: We compared the short (30 days postoperatively) and mid-term (up to 24 months postoperatively) results of 498 patients with intracardiac defect who underwent surgical correction using Dacron patch (group 1) between March 1993 and December 2003 with 533 patients who received a bovine pericardial patch (group 2) between January 2004 and April 2010. Results: The short- and mid-term postoperative echocardiographic studies showed no evidence of calcification, thrombus, aneurysmal dilatation around the patch in either group. Vegetation-endocarditis developed in three patients in group 1 and two patients in group 2. Residual ventricular septal defect developed in 15 patients in group 1 and in 14 patients in group 2. The incidence of these complications was not statistically significant between the groups. Conclusion: Our study results suggest that bovine pericardial patch is more appropriate in repair of simple and complex intracardiac defects thanks to its elasticity and easy-to-use nature, compared to Dacron patch.

WOS: 000321798900010 Background: In this study, we compared the short- and mid-term clinical and transthoracic echocardiographic results of bovine pericardial and Dacron patch materials used in repair of intracardiac defects. Methods: We compared the short (30 days postoperatively) and mid-term (up to 24 months postoperatively) results of 498 patients with intracardiac defect who underwent surgical correction using Dacron patch (group 1) between March 1993 and December 2003 with 533 patients who received a bovine pericardial patch (group 2) between January 2004 and April 2010. Results: The short- and mid-term postoperative echocardiographic studies showed no evidence of calcification, thrombus, aneurysmal dilatation around the patch in either group. Vegetation-endocarditis developed in three patients in group 1 and two patients in group 2. Residual ventricular septal defect developed in 15 patients in group 1 and in 14 patients in group 2. The incidence of these complications was not statistically significant between the groups. Conclusion: Our study results suggest that bovine pericardial patch is more appropriate in repair of simple and complex intracardiac defects thanks to its elasticity and easy-to-use nature, compared to Dacron patch.

A giant aneurysm in the right sinus of Valsalva compressed the right coronary artery and caused angina pectoris in a 44-year-old man. Surgical correction consisted of obliterating the orifice of the aneurysm with a Dacron patch and relocating the right coronary artery. Postoperative angiography demonstrated excellent results. Pathological study demonstrated the absence of normal elastic fibers in the media of the aneurysm.

Patch angioplasty using synthetic materials such as Dacron and polytetrafluoroethylene has become the standard of care after carotid endarterectomy. This method has been shown to reduce recurrent stenosis and stroke as compared to primary closure. Complications, including infection and pseudoaneurysm, are very rare. Another complication that has been described in two case reports to date is the late rejection of a polytetrafluoroethylene patch. We present the first reported case of a late Dacron patch expulsion 4 years after carotid endarterectomy. The patient was managed conservatively after a selective carotid arteriogram demonstrated no evidence of stenosis or pseudoaneurysm formation.

To assess the feasibility of intravascular ultrasound imaging during carotid endarterectomy. Intravascular ultrasound imaging was performed during carotid endarterectomy in eight patients using an over-the-wire catheter system with a 30-MHz ultrasound probe. In vitro studies were carried out before the intraoperative application, paying special attention to visualization of the wall layers of normal carotid arteries, structures of more or less diseased vessels, and surgically placed materials such as patch, suture material, and fibrin glue. Although intravascular ultrasound failed to distinguish between intima and media in areas of normal intima, fibrotic and calcified plaques were detected clearly. Dacron patch as well as sutures were identified as highly reflective structures. In seven of the eight patients studied, intravascular ultrasound yielded cross-sectional images of good quality allowing identification of the vessel layers and the structures at the endarterectomy site. In all patients the three layers of the vessel wall were clearly differentiated and the transition zone between the site of endarterectomy and the genuine vessel appeared smooth without intimal flaps or residual arteriosclerotic plaques. In one patient severe eccentric thickening of the media was detected in the distal internal carotid artery. Neither damage of the vessel layers by the shunt nor thrombus formation in the operating area and the internal carotid artery were detected. Intravascular ultrasound lends itself as a potentially valuable method of quality control during carotid endarterectomy. The method seems to enable an accurate evaluation of the endarterectomy site and the search for residual plaques.

Fistulous communication between the aorta and the pulmonary parenchyma developed in a 38-year-old woman 19 years after repair of a congenital aortic coarctation with Dacron patch aortoplasty. The fistula, inducing intermittent hemoptysis, arose from the suture line between the prosthetic fabric and the aorta. There was no infectious background or aneurysm at the primary repair site. The aortic segment including the prosthetic patch was resected and replaced with a Dacron tubular vascular prosthesis.

A Dacron patch/tube graft was developed specifically to avoid technical complications associated with lateral aortic anastomoses of medium-diameter grafts. This new prosthetic device has now been used in 15 patients without complications. It seems to be particularly useful in patients with thick-walled aortas.

Our previous investigations showed that retroviral gene transfer of tissue-type plasminogen activator (tPA) effectively targeted thrombolysis in vitro and in the model of inferior caval veins of rabbits. This study is to identify the target thrombolysis of retroviral vector recombinant pLEGFP-N1-tPA transferred into the tissue around the Dacron patch (the same materials making of the ring of mechanical valve) in left atriums of rabbits. 70 Dacron patches were transplanted into the left atriums of 70 New Zealand white rabbits. The rabbits were randomly divided into three groups according to the different handling methods, including local pLEGFP-N1-tPA transferred group (gene therapy group, 30 animals), pLEGFP-N1 transferred group (control group, 20 animals), medium DMEM + 10% neonate calf serum (NCS) injected group (blank control group, 20 animals). Samples of blood, Dacron pieces and left atriums (auricles) wall from half of above in each group were harvested on second day and another half were harvested on 75th day after surgery. The EGFP expression of harvested left atriums (auricles) wall were observed under the confocal. The thrombi on the surface of Dacron patches were detected by stereoscope and electron microscope. The tPA expression in left atriums (auricles) wall and in blood from left atriums were detected by Western blot and their thrombolysis and activities were observed and calculated in plasma plates. ELISA were used to identify the contents of tPA. No thrombus was seen on the surface of Dacron patches that were transplanted in left atriums by tPA locally transferring around them. Activity and content of tPA were high in local tissue of left atrium and in blood of left atrium. It demonstrated effectively thrombolysis by tPA rapidly, efficiently and long expressing. This puts the foundation of mechanical valve replacement model for tPA gene valve, next.

The outcomes of 3 different methods of repair of left ventricular pseudoaneurysm after myocardial infarction were analyzed retrospectively. The operations were carried out in 22 patients between 1985 and 2008. Repair procedures included primary closure with Teflon-pledgeted sutures, and Dacron or pericardial patches. Overall hospital mortality was 27.3% (2 patients had primary closure, 3 had a Dacron patch, and 1 had a pericardial patch). Mean postoperative bleeding was 885 mL (range, 200-4,800 mL). Mean preoperative and postoperative ejection fractions were 40% (30%–47%) and 48% (30%–65%), respectively. The overall incidence of arrhythmia was 36.4% (8 patients). The incidence of arrhythmia was lowest in the pericardial patch group, but this was not statistically significant. No significant differences in postoperative ejection fraction or hemorrhage were found among the study groups. Mean survival was 61.9 ± 41.4 months in the 16 hospital survivors. Although the 3 techniques gave similar results, repair with an autologous pericardial patch may offer an advantage in terms of less postoperative arrhythmias.

The trend toward early operation for acquired ventricular septal defects exposes the patient to major perioperative bleeding and residual shunt because of the fragility of the recently necrosed myocardium. To reduce these complications we have used a fibrin sealant to reinforce the cardiac tissues in addition to the usual closure of the defect with a Dacron patch through a left ventriculotomy in the infarcted area. During cardiac arrest fibrin sealant is applied on the ventricular septum around the defect, between the septum and the patch, and on the edges of the ventriculotomy. This technique was used in three patients (mean age 68.2 years) operated on for an acquired ventricular septal defect within 4 days of the infarction and within 24 hours of the occurrence of the defect. Low postoperative bleeding, absence of recurrent shunt, and good ventricular function indicated satisfactory surgical result in all three patients. We suggest that the use of fibrin sealant during operations for acquired ventricular septal defects, by reinforcing the necrotic and fragile tissues, may reduce perioperative bleeding and assure a more solid implantation of the patch. (J T horac C ardiovasc S urg 1992;104:748-51)

Introduction Common femoral endarterectomy and/or profundoplasty are procedures commonly performed on patients with functional or critical limb ischaemia. Case presentation A 61-year-old Caucasian British man was referred to our unit with recent onset of severe left calf and thigh claudication and rest pain in his left foot. Magnetic resonance angiography revealed occlusive disease of the left common femoral artery, proximal superficial and profunda femoral arteries. These findings were confirmed intraoperatively and an endarterectomy was subsequently performed from the left common femoral onto the proximal superficial femoral artery and then onto the proximal profunda femoris artery. The arteriotomy was closed with a Dacron patch and its distal end was bisected into two to patch the profunda femoris and superficial femoral arteries. The patient made an uneventful recovery with a full clinical improvement of his left leg. Conclusion A Dacron patch that was bisected distally to make a bifurcated patch for simultaneous patching of the profunda femoris artery and the superficial femoral artery was used to treat our patient's occlusions. This technique has not been previously described in the published literature and we have found it easy to do with little time added to conventional operation.

We present the case of a 39-year-old man with recurrence of intermittent claudication 4 years after successful Dacron patch repair of the right common femoral artery for cystic adventitial disease. Magnetic resonance angiography results were inconclusive, while conventional angiography demonstrated 90% stenosis of the right common femoral artery. The patient underwent excision and replacement of the affected artery with PTFE and was asymptomatic at 6-month follow-up. In recurrent cystic adventitial disease, excision and replacement of the affected artery with a prosthetic interposition graft provides a successful outcome with minimal chance of recurrence.

Coarctation of the aorta is a diaphragmlike ridge narrowing the lumen of the proximal descending aorta. Although surgical repair has proven to be a successful treatment of coarctation of the aorta, immediate and delayed postoperative complications are not rare. Of particular interest is the occurrence of aneurysms after Dacron patch aortoplasty--often decades after surgery. Delayed complication rates of up to 50% have been reported. We describe the clinical-radiologic presentations of 3 late complications of Dacron patch angioplasty: aortobronchopleural fistula, leaking pseudoaneurysm, and giant descending aortic aneurysm--all successfully treated with bypass grafts. Because of the high incidence of delayed complications, lifelong surveillance is necessary. The chest x-ray may be the first clue to a delayed complication. Knowledge of radiologic findings is helpful in the detection of complications-before they become symptomatic. Transesophageal echocardiography, computed tomography angiography, or magnetic resonance imaging with multiplanar reconstruction is diagnostic.

We report on a 58-year-old male who presented with an enlarging cervical hematoma 3 months following carotid endarterectomy with Dacron patch repair, due to septic disruption of the Dacron patch secondary to presumed infection. The essential features of this case are the control of the proximal common carotid artery gained through a median sternotomy, because the patient was markedly obese with minimal thyromental distance, and the treatment consisting of in situ polytetrafluoroethylene bypass grafting, due to the absence of a suitable autogenous saphenous vein. Median sternotomy is rarely required in case of reintervention for septic false aneurysms and hematomas following carotid endarterectomy but should be considered whenever difficult control of the common carotid artery, when entering the previous cervicotomy, is anticipated. In situ polytetrafluoroethylene grafting can be considered if autogenous vein material is lacking.

Background Supravalvular mitral ring is exceedingly uncommon. Methods We report a 4-year-old girl with supravalvular stenotic mitral ring and ventricular septal defect (VSD). The VSD was closed by a Dacron patch and the supravalvular ring was excised. For treatment of supravalvular mitral ring with obstruction, surgical resection is commonly performed. Results There are no reports of long-term follow-up after resecting the supravalvular mitral ring. Conclusion In our case, no mitral stenosis was evident on postoperative echocardiogram performed 3 years after surgery.

This is an analysis of restenosis after bilateral carotid endarterectomy (CEA) with saphenous vein patch reconstruction on one side and Dacron patch reconstruction on the other. The possibility that differences in reconstruction geometry between vein and Dacron patched sides effected restenosis outcomes was evaluated as was the value of serial common carotid wall thickness measurements in predicting restenosis. Between 1990 and 1997, 33 bilateral CEA were performed within one year on 22 men and 11 women using a greater saphenous vein patch on one side and a knitted Dacron patch on the other. Interoperative post-CEA geometry was measured. Follow-up was by duplex scans that included wall thickness measurements in the endarterectomized common carotid bulb. Over a mean follow-up of 43 months 10 (30%) Dacron patched and one (3%) vein patched CEA developed?25% restenosis (p=0.001), seven (21%) Dacron patched and no vein patched CEA developed >50% restenosis (p=0.01) and four (12%) Dacron patched and no vein patched CEA developed >70% restenosis (p =0.1 1). The Kaplan-Meier cumulative >25% restenosis rates for Dacron and vein patched CEA were 22% and 0% at 2 years and 41% and 5% at 5 years respectively (p=0.002). The cumulative >50% restenosis rates for Dacron and vein patched CEA were 16% and 0% at 2 years and 34% and 0% at 5 years respectively (p = 0.003). The cumulative?70% restenosis rates for Dacron and vein patched CEA were 8% and 0% at 2 years and 20% and 0% at 5 years respectively (p = 0.02). For both patients with and without recurrent stenosis the mean within patient between sides differences of the diameters of the internal carotid, internal carotid bulb, common carotid bulb, and common carotid arteries and the lengths of the internal carotid and total patch segments were not significantly different and all were less than 5%. Common carotid bulb wall thickness measured at the time of identification of the nine unilateral Dacron patched CEA restenosis was 1.5 ±0.5 mm compared to 1.4 +0.4 mm (m ± 1 SD) for the contralateral vein patched CEA (p = 0.45 by paired t test). Dacron patched CEA have a significantly higher incidence of mild, moderate and severe restenosis than do saphenous vein patched CEA independent of systemic risk factors. The within patient equality of Dacron and vein patched carotid reconstruction geometry in patients with unilateral restenosis indicates that patch material is the major local risk factor, not adverse hemodynamics produced by variance in geometry. Common carotid bulb wall thickness measurements after CEA are not predictors or indicators of recurrent stenosis.

A 35-year-old woman presented with a saccular thoracic aortic aneurysm at the site of a previous Dacron patch repair for aortic coarctation (Figure 1). The aneurysm was initially treated with 2 covered stents (NuMed CP), 50 and 39 mm long. Follow-up angiography revealed …

Circular elasticity cannot be obtained in standard patch aortaplasty in patients with coarctation of aorta. We inserted Dacron patch perpendicularly to standard fashion. The creases of Dacron patch became parallel to descenden aorta. Circular elasticity, that reduces both true and false aneurysm incidence in the long-termperiod, can be obtained with this modification.

Infected aneurysms of the thoracic aorta are rare in children, and many are not diagnosed until autopsy. We report the case of a 3-year-old girl in whom an infected aneurysm of the ascending aorta was successfully repaired by Dacron patch angioplasty under cardiopulmonary bypass.

A successful closure of an aneurysmal aorto-right ventricular tunnel (ARVT) in a 16-year-old male patient is reported here. An attempt at device closure had failed in this patient. Diagnosis was confirmed by Doppler echocardiography, 3-dimensional computed tomography, and cardiac catheterization. Surgical closure with a Dacron patch (W.L. Gore & Associates, Flagstaff, AZ) at the aortic end and direct closure at the ventricular end was done successfully with the patient under mild hypothermia. The postoperative echocardiogram showed a competent aortic valve with a closed ARVT.

Between May 1977 and June 1998, 697 patients with congenital heart diseases were admitted to the cardiothoracic surgical unit (CTSU) at the University College Hospital, Ibadan. Eighteen (2.6 per cent) of the patients with 19 coarctations of the aorta (CoA) were retrospectively studied. The age range of all the patients with CoA was 18 days to 30 years (mean 7.2±8.2 years), but for the 15 patients who underwent surgery, it was one month to 30 years (mean 8.6±8.3 years). Three patients died preoperatively of congenital cardiac anomalies associated with infantile CoA. There were 16 thoracic and two abdominal CoA, while one patient had recurrent CoA. Resection and end-to-end anastomosis was performed in four patients, dacron tube interposition graft in three, and dacron patch graft in four patients. Other procedures were employed in five patients. Operative mortality was 25 per cent. Operative deaths occurred in two infants with isolated CoA, a neonate who had associated pulmonary hypertension and a 17-year old who had surgery for re-coarctation. Complications of surgery included post-operative haemorrhage in two patients, intra-operative hemorrhage in one and hoarseness of the voice in four patients. Paradoxical hypertension occurred in three patients, graft occlusion and wound dehiscence occurred together in one patient and two patients had chylothorax. It is concluded that CoA is a surgically correctable congenital anomaly which is probably less frequently diagnosed locally. Nigerian Journal of Paediatrics 2002;29:27-33.

We report a case of a 69-year-old female with a previous Bentall procedure who developed a right coronary ostial aneurysm. The aneurysm was excluded with a Dacron patch and the right internal mammary artery was used to restore flow to the coronary artery.

Postinfarction ventricular septal defect is a serious complication of acute myocardial infarction. Early surgical repair is the treatment of choice. Closure of the septal rupture is a demanding technical problem. We describe our experience with a modified technique to close the defect using a dacron patch, fibrin sealing, and a continuous suture in the undamaged septum. Of 7 patients, five survived. One patient had a small residual VSD. These initial results are encouraging.

We report a case of recurrent malignant fibrous histiocytoma (MFH) of the left atrium. The primary lesion was surgically removed after it had been diagnosed to be the cause of fulminant pulmonary edema in a 27-year-old male. The tumor recurred 15 weeks following surgery. It was excised completely, leaving a large left atrial defect that was reconstructed using a Dacron patch. Malignant fibrous histiocytoma constitutes 2% of all cardiac malignancies. The typical location is the left atrium. Surgical excision is the primary aim in treating this tumor. Adjuvant radiotherapy and chemotherapy have been suggested in the literature. The prognosis is poor.

A 38-year-old man presented with massive hemoptysis followed by hemorrhage shock. The patient's history revealed a Dacron patch repair for aortic coarctation and recoarctation carried out twice, once 23 and once 10 years ago. Diagnosis of a ruptured descending aortic aneurysm with an aortobronchial fistula into the left lower lobe was established using CT scan. Emergency surgery consisted of left pneumonectomy and descending aortic graft replacement during deep hypothermic circulatory arrest. The patient was discharged 12 days later.

Aortoventricular disruption after aortic valve replacement is extremely rare. A case of aortoventricular disruption following aortic valve replacement is described in detail, and related case reports are reviewed. A 76-year-old male underwent aortic valve replacement with a tissue valve using everting mattress sutures, repair of the ascending aortic aneurysm, and mitral valve repair. After cardiopulmonary bypass was terminated, pulsatile bleeding behind the aortic root was observed, which required cardiopulmonary bypass. The ventricular rupture was located just below the left coronary annulus, and appeared secondary to a tear through the ventricular myocardium by the valve sutures. The tear was internally repaired by pledgeted sutures and Dacron patch reinforcement. The patient recovered and was discharged without major complications. Although this serious complication is extremely rare, surgeons should be aware that deep everting stitches on the left coronary annulus potentially causes aortoventricular disruption. Overstretching the posterior aortoventricular junction may contribute to this type of injury.

A 17-year-old woman with ventricular septal defect and tricuspid straddling valve. There are few reports about these associations in literature. We successfully performed a total correction which consisted of a close of the ventricular septal defect and suspension of straddling tricuspid valve. Ventricular septal defect was closed with a dacron patch and straddling tricuspid valve was suspended into the appropriate ventricle. The postoperative course has been uneventful.

We describe the finding of an aortic aneurysm in an asymptomatic 43-year-old male, who was managed by Dacron patch aortoplasty for native coarctation of the aorta 25 years before. The role of magnetic resonance angiography as standard imaging technique in lifelong postoperative surveillance is discussed subsequently. (Neth Heart J 2010;18:376-7.).

A patient with a large posterolateral left ventricular pseudoaneurysm flush with the posterior papillary muscle and associated with mitral regurgitation was successfully treated surgically. The operation consisted of opening the sac of the aneurysm, dissecting the wall of the left ventricle from the fibrous wall of the sac, leaving a cuff of fibrous tissue suitable to hold sutures, and closing the defect with a Dacron patch.

We report a case of haemoptysis from a leaking false aneurysm associated with a Dacron patch used to repair coarctation of the aorta twelve years earlier in a 17-year-old girl. This case illustrates a late and potentially fatal complication of this type of operation after a long period of apparent normality. It emphasises the need for informed follow-up and appropriate correctly timed investigations.

We report an unusual adult case of aneurysm associated with the ductus arteriosus. A 67-year-old female, who suffered recurrent nerve palsy, was diagnosed as having an aneurysm of the ductus arteriosus. The aneurysm, located in the medial aspect of the aortic ischimus and projected toward the pulmonary artery, was successfully repaired using a Dacron patch. A pathologic review of the aneurysm revealed the degeneration of the aortic media.

A 25-year-old man died 10 years after a Dacron patch was used to repair a coarctation of the aorta. Death was due to rupture of an unrecognized aneurysm at the site of the patch. After the initial operation at the age of 15 years, there had been no signs of residual or recurrent obstruction. He had no evidence of hypertension and was discharged some years later from regular hospital follow-up to the care of his general practitioner. We strongly recommend that patients who have undergone repair of aortic coarctation by patch aortoplasty should have lifelong follow-up in cardiac units with imaging facilities for monitoring aortic dilation. We would now recommend surgical intervention in the presence of progressive aortic dilation.

Objectives : Experimental studies have demonstrated that decreases in vessel wall compliance and increases in turbulence may contribute to (re)stenosis. We studied vessel wall and flow characteristics after endarterectomy with Dacron patch plasty and after eversion endarterectomy, and compared those findings with the characteristics of non-stenotic, unoperated carotid arteries (controls). Methods : Seventy-four patients who underwent 84 carotid endarterectomies were studied postoperatively by ultrasonography (2–24 months) Recorded variables included the diameter of the bulb, strain, elastic modulus (stiffness), and presence of turbulent flow. Results : The vessel wall and flow characteristics of the two groups differed significantly. The diameter was higher and the strain lower in Dacron patch plasty than in controls; eversion endarterectomy did not differ from controls. The elastic modulus was higher (stiffer) in Dacron patch plasty than in eversion endarterectomy; neither Dacron patch plasty nor eversion endarterectomy differed significantly from controls. The stiffness index was not significantly different between the groups. Turbulence was present in Dacron patch plasty and eversion endarterectomy when compared with controls. Conclusion : In diameter, strain and stiffness, the operated carotid artery resembles the non-stenotic, unoperated artery more closely after eversion endarterectomy than after Dacron patch plasty.

A 67-year-old woman presented to the emergency department with acute back pain and progressive dyspnea during a 7-day period. In addition, the patient noticed reduced urine production and we documented elevated plasma D-Dimers (3.99 mg/L) that were nearly 40-fold higher than normal ( 0.19 mg/L). A spiral chest computerized contrast tomography scan was obtained to screen for thromboemboli within the pulmonary arteries. The scan revealed that several thrombi were embedded in the main and segmental pulmonary arteries (Figure 1). Subsequent venous ultrasonography was negative for deep venous thrombosis. Next, we performed transthoracic echocardiography that was partially obscured because the patient was obese. Nevertheless, the right ventricle was enlarged and we observed a free-floating structure within the right atrium. Therefore, we performed transesophageal echocardiography that detected an intracardial thrombus. The thrombus size was 50 25 mm in the right atrium and 20 20 mm in the left atrium. This free-floating thrombus crossed a persistent foramen ovale (Figure 2). The patient underwent open heart operation to remove the thrombus (140 11 mm) and the persistent foramen ovale was closed with an atrial septum Dacron patch (Figure 3). The cause of the thromboemboli was unclear because all of the coagulation factors were within the normal range. However, a subsequent abdominal computerized contrast tomography scan demonstrated that a suggestive tumor was lodged between the right uterine tube and ovary. A laparotomy performed by colleagues in the department of gynecology revealed that the tumor was an ovarian