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Ann Thorac Surg 2006;82:1949
© 2006 The Society of Thoracic Surgeons

Correspondence

Early Complication After Repair of Truncus Arteriosus With Contegra Conduit

Thomas Z. Kocher, MDa, Joseph P. Pestaner, MDa, Theodore C. Koutlas, MDb

a Department of Pathology, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC 27834
b Department of Cardiothoracic Surgery, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC 27834

(Email: kochert{at}mail.ecu.edu).

To the Editor:

We read with interest the article by Tiete and colleagues [1] regarding the use of the Contegra pulmonary valved conduit (Medtronic, Minneapolis, MN) in the reconstruction of the right ventricular outflow tract. In this article, 2 patients with thrombus formation at the conduit valve were described with successful treatment using low-molecular weight heparin.

We observed the case of a 30-day-old infant who had sudden cardiac arrest after repair of truncus arteriosus with a Contegra conduit (Medtronic). The decedent was a term infant with type III truncus arteriosus and moderate-to-severe insufficiency of a quadricuspid truncal valve.

On day 8 of life, a repair of the truncus arteriosus was performed, which included the creation of a right ventricular outflow tract using a 14-mm Contegra conduit (Medtronic).

Follow-up echocardiography on postoperative day 6 showed excellent surgical results from the repair. Among the findings, no intracardiac masses or thrombi were noted. A further report on postoperative day 16 showed similar findings.

On postoperative day 22, a witnessed ventricular tachycardia degraded to pulseless electrical activity. After 50 minutes of cardiopulmonary resuscitation without establishing a stable rhythm, the infant was pronounced dead.

On autopsy examination, limited to the thoracic cavity, two occlusive white-tan emboli were found at the pulmonary artery bifurcation at the distal aspect of the Contegra conduit (Medtronic). The emboli were concave and cusp-shaped, with a gross appearance similar in size and shape to the leaflets of the valve present within the conduit. At the site of the conduit valve, a cast was removed at one of the cusps, which was similar in appearance to the emboli previously described. Microscopic examination of the casts showed fibrin deposition. All anatomoses were intact, and the coronary arteries were fully patent. The heart was grossly enlarged but showed no evidence of myocardial infarction.

As addressed by Tiete and colleagues [1], prophylactic anticoagulation in infants after repair of congenital anomalies should be considered. Currently the use of prophylactic aspirin or therapeutic heparin is suggested for use in patients after the Fontan procedure according to current guidelines; however this came with a grade 2C recommendation from the American College of Chest Physicians [2].


   References
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 References
 

  1. Tiete AR, Sachweh JS, Roemer U, Kozlik-Feldmann R, Reichart B, Daebritz SH. Right ventricular outflow tract reconstruction with the Contegra bovine jugular vein conduit: a word of caution Ann Thorac Surg 2004;77:2151-2156.[Abstract/Free Full Text]
  2. Monagle P, Chan A, Massicotte P, Chalmers E, Michelson AD. Antithrombotic therapy in children: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest 2004;126(Suppl 3):645S-687S.[Abstract/Free Full Text]




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