The Pericardial Graft in Mitral Insufficiency

(A Morphological Study of the Aging Graft)

¹ The Division of Pathology and Department of Thoracic Surgery, Hahnemann Medical College and Hospital, Philadelphia 2, Pennsylvania.

Techniques applied to surgical correction of mitral insufficiency include the application of autogenous pericardial grafts. The sequence of pathological changes in seven pericardial grafts in humans with mitral insufficiency is here presented. The age of the grafts ranged from three days to 22 months. Regressive changes were noticed in the early transplants and they were followed by subsequent proliferation of granulation tissue. Ultimately the graft was seen to consist of a sclerosed, poorly vascularized band of fibrous connective tissue. Swelling of the strip was constantly found in specimens obtained at the third, fifth, and seventh day following surgery. Secondary obstruction of the mitral valve opening is a possible complication related to this alteration. In two of the older specimens obtained 45 days and six months after surgery, the pericardial strip was seen to adhere to the valve leaflets by dense fibrous connective tissue. This also must be regarded as an unfavorable result inasmuch as it can produce fixation of the valve either in regurgitation or in stenotic position.