Initial clinical experience with rectus sheath grafts in congenital heart defects

This study reports on the initial clinical experience using anterior rectus sheath as potentially growing graft material in congenital heart lesions. The first seven patients with complex congenital lesions requiring a rectus sheath graft because of inadequate available pericardium are reviewed. The initial operations were: TOF (unicusp pulmonary valve) (re-op), two Konno procedures (one VSD and one RV patch), two arterial switch procedures for TGA (neoaortic augmentation), two Fontan (re-op) atrial augmentation patch and pulmonary arterioplasty (re-op). Ages ranged from 1 week to 15 years. Follow-up ranged from 1 to 72 months and included open visual inspection at reoperation in 5 cases, angiography in 3 cases, and echocardiography in 4 cases. One early respiratory death occurred in the fourth postoperative week. So far no early bleeding from rectus sheath patches, infection, aneurysmal dilatation, or scar contraction was observed. No manifestation of peripheral emboli was seen. Hernias of the harvest site were absent. We concluded that in absence of pericardium and in areas where future cicatrization or aneurysmal dilatation is undesirable, anterior rectus sheath appears to be a reasonable alternative.