Epoxy- versus Glutaraldehyde-Treated Bovine Jugular Vein Conduit for Pulmonary Valve Replacement: A Comparison of Morphological Changes in a Pig Model

Figures

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  Figure 1. Study design. DE-BJV, diepoxy-treated bovine jugular vein; GA-BJV, glutaraldehyde-treated bovine jugular vein.

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  Figure 2. Implantation of a conduit in the pulmonary position: (A) left thoracotomy and pulmonary trunk mobilization (the green arrow); (B) graft implantation, and the creation of proximal anastomosis between the PA and BJV conduit, where the blue arrow indicates the BJV conduit; (C) a BJV conduit in the pulmonary position, where the blue arrow indicates the BJV conduit.

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  Figure 3. Macrophotographs of explanted conduits after 6 months of follow-up. (A) A DE-BJV; the black arrow indicates a thin neointimal layer, and the green arrow indicates intact valve leaflets. (B) A DE-BJV; the black arrow indicates neointimal hyperplasia. (C) A Contegra graft; the black arrow indicates thick neointima, and red arrows indicate fibrin and thrombotic masses. (D) A GA-BJV; the black arrow indicates substantial neointimal hyperplasia, and the purple arrow indicates a deformed leaflet, partially fused with the conduit wall.

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  Figure 4. Microphotographs of explanted conduits after 6 months of follow-up: (A–C) H&E overview images; bars are 50 μm. (D–F) H&E, conduit wall structure, bars 10 μm. (G–I) von Kossa staining, ×400; bars are 10 μm. (J–L) Russel–Movat pentachrome staining ×400; bars are 10 μm, where black arrows indicate mineralization sites, while green arrows indicate migrating fibroblasts, yellow arrows indicate elastin fibers, blue arrows indicate collagen fibers, purple arrows indicate hyalinosis and chondroid metaplasia, red arrows indicate an endothelial monolayer and the orange arrow indicates the absence of an endothelium. *—neointima; #—conduit tissue.

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  Figure 5. Microphotographs of DE-BJV graft; H&E staining: (A) Valve leaflet; green arrows indicate migrating fibroblasts. (B) Site of mineralization; black arrows indicate mineral clusters and the blue arrow indicates suture hole; (C) A giant cell granuloma; orange arrows indicate giant cells, and the yellow asterisk indicates granuloma tissue. Magnification, ×400; bar, 10 μm.

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  Figure 6. IHC staining for S100 proteins. (A) Contegra; luminal surface; magnification, ×100. (B) Contegra; luminal surface; magnification, ×400. (C) Hyalinosis in anastomosis area. Black arrows indicate subintimally located S100-positive cells, showing signs of chondroid metaplasia, and the purple arrow indicates S100-positive cells inside a focus of hyalinosis. *—neointima; #—conduit tissue; °—graft lumen. Bars—10 μm.

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  Figure 7. SEM images and EDS maps of dried sections. Yellow arrows indicate elastin fibers. Bars—50 μm.