Late hemodynamic results of fascia lata reconstruction of the right ventricular outlet.

Eight patients were catheterized between 1.2 and 2.4 years after reconstruction of the right ventricular outflow tract with autologous fascia lata. Whereas the immediate post-bypass pressures had demonstrated a maximum gradient of 15 mm. Hg across the fascial valve at the time of recatheterization, this varied from 55 to 142 mm. Hg (mean 83 mm. Hg). Right ventricular systolic pressure varied between 80 and 160mm. Hg (mean 106 mm. Hg). All but one patient had clinical evidence of pulmonary incompetence. Selective angiography with injection into the right ventricle and pulmonary artery demonstrated shrunken, thickened, immobile valve cusps with an abrupt stenosis of the fascial tube or a diaphragm across it. Re-operation has been done in five patients. In each, the graft tube functioned satisfactorily, but at the site of the "valve," no leaflets were visible, and the orifice of the conduit narrowed abruptly to 6 to 10 mm. in diameter. It is concluded that autologous fascia lata is unsuitable for reconstruction of the right ventricular outflow tract.