Ferrans V J, Spray T L, Billingham M E, Roberts W C
Am J Cardiol. 1978 Jun;41(7):1159-84. doi: 10.1016/0002-9149(78)90873-1.
Scanning and transmission electron microscopic studies were made of (1) 12 glutaraldehyde-treated porcine valvular heterografts that had been implanted in patients for 2 days to 76 months; (2) 3 unimplanted commercially processed porcine aortic valves; and (3) 1 unprocessed porcine aortic valve. Comparison of unprocessed porcine valves and unimplanted commercially processed valves showed loss of endothelium and acid mucopolysaccharides during preimplantation processing. Short-term (less than 2 months) changes after implantation consisted of insudation of plasma proteins, penetration of erythrocytes into surface crevices, formation of a thin surface layer of fibrin, and deposition of macrophages, giant cells and a few platelets. Longer-term (more than 2 months) changes were proportional to the time interval after implantation and consisted of progressive disruption of collagen, erosion of the valve surfaces, formation of aggregates of platelets and accumulation of lipid. The surfaces of the leaflets did not become covered with endothelium or with a fibrous sheath. Calcific deposits were found in one valve and bacterial organisms in another. Thus, progressive breakdown of collagen appears to be a critical factor in determining the long-term durability of glutaraldehyde-treated porcine valvular heterografts.
(1) 12个经戊二醛处理的猪瓣膜异种移植物，已植入患者体内2天至76个月；(2) 3个未植入的商业加工猪主动脉瓣；(3) 1个未加工的猪主动脉瓣。未加工猪瓣膜与未植入的商业加工瓣膜的比较显示，植入前处理过程中内皮和酸性粘多糖会流失。植入后的短期（少于2个月）变化包括血浆蛋白渗入、红细胞穿透至表面裂隙、形成一层薄薄的纤维蛋白表面层，以及巨噬细胞、巨细胞和少量血小板的沉积。长期（超过2个月）变化与植入后的时间间隔成正比，包括胶原蛋白的逐渐破坏、瓣膜表面的侵蚀、血小板聚集体的形成以及脂质的积累。瓣叶表面未被内皮或纤维鞘覆盖。在一个瓣膜中发现了钙化沉积物，在另一个瓣膜中发现了细菌。因此，胶原蛋白的逐渐分解似乎是决定戊二醛处理的猪瓣膜异种移植物长期耐久性的关键因素。
