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Background Bovine Pericardium (BP), with numerous and improving preparation techniques, has been used extensively for over 50 years in repair of simple and complex congenital heart defects. It has several advantages over other surgical materials. However, there is a paucity of data in the pediatric population regarding complications associated with BP. Herein, we report two rare complications noted with BP use. Case Description Case 1. A 14-month-old male, with trisomy 21 and complete Atrioventricular canal defect, repaired using BP. A routine surveillance echocardiogram showed a mass attached to the atrial septum and atrial aspect of the left atrioventricular valve (Figure 1A). Surgical intervention was deemed necessary as serial echocardiogram after admission showed an enlarging mass. Pathology showed a fibrin thrombus undergoing transition to granulation tissue. Case 2. A 10-month-old girl, with mosaic trisomy 9 and Tetralogy of Fallot, underwent a transannular patch repair using BP. An outpatient follow-up echocardiogram showed fluid collection around RVOT patch with intraluminal compression with a confirmatory CT angiogram (Figure 1B). Redo median sternotomy revealed purulent appearing fluid within an intact patch. Fluid culture showed no growth and pathology sections revealed fibrous tissue with a mixed inflammatory cell infiltrate including necrotizing granulomas. Conclusion These two cases illustrate that, albeit rare, complications can occur with the use of BP in the pediatric population. In our patients, thrombus and sterile abscess occurred within six months postoperatively and were incidentally identified. Literature is presently inconclusive about the exact mechanism for the inflammatory reaction noted with BP use and warrants further research.


Cardiology | Pediatrics


Presented at the 2023 Midwest Cardiology Meeting and 15th Annual Cardiovascular Ultrasound Conference; September 21–23, 2023; Cincinnati, Ohio.

Rare Complications Associated with Use of Bovine Pericardium