Abstract
Pulmonary valve autografts have proven to be valid aortic valve substitutes in children. The objective of this study is to evaluate the performance of the pulmonary autograft (PAG) in systemic position and its adjustment to growth in four infants who underwent a Ross operation. Between April 1998 and January 2000, four infants whose aortic valve anatomy and function were judged unsuitable for a valve-sparing operation underwent successful Ross operation. All patients were followed postoperatively with echocardiograms to evaluate the function and the dimensional changes of the PAG within the systemic circulation. The PAG adjustments to growth were compared to the growth of the pulmonary root of healthy patients matched for body surface area, with the purpose to evaluate the effects of the systemic pressure on the pulmonary vascular wall, as a passive dilatation process versus a true and active structural adaptation. Median follow-up was 53 months (range, 48–65). There were no early deaths or reoperations. All patients were asymptomatic and in stable hemodynamic conditions. The PAG annulus grew according to body surface area without dilatation. PAG valve regurgitation was present but mild in three patients. Trans-PAG peak gradients were not significant. The PAG diameter at the level of the sinuses of Valsalva and sinotubular junction increased rapidly and steadily in all patients during follow-up compared to controls.
The Ross operation in infants provides acceptable immediate surgical and hemodynamic results. However, significant midterm increases in PAG sinuses and sinotubular junction diameters require close and continued observation.
Similar content being viewed by others
References
C Alexiou A McDonald SM Langley et al. (2000) ArticleTitleAortic valve replacement in children; are mechanical prostheses a good option? Eur J Cardiothorac Surg 17 125–133 Occurrence Handle1:STN:280:DC%2BD3c7psl2hsg%3D%3D Occurrence Handle10731647
DR Clarke DN Campbell AR Hayward DA Bischop (1993) ArticleTitleDegeneration of aortic valve allografts in young recipients J Thorac Cardiovasc Surg 105 934–942 Occurrence Handle1:STN:280:ByyB2Mvgsl0%3D Occurrence Handle8487572
TE David A Omran J Ivanov et al. (2000) ArticleTitleDilatation of the pulmonary autograft after the Ross procedure J Thorac Cardiovasc Surg 119 210–220 Occurrence Handle10.1067/mtc.2000.104725 Occurrence Handle1:STN:280:DC%2BD3c7hsFOnsg%3D%3D Occurrence Handle10649195
G Gerosa R McKay J Davis DN Ross (1991) ArticleTitleComparison of the aortic homograft and the pulmonary autograft for aortic valve and root replacement in children J Thorac Cardiovasc Surg 102 51–60 Occurrence Handle1:STN:280:By6A3cvgtlc%3D Occurrence Handle2072729
JA Hawkins LL Minich RE Shaddy et al. (1996) ArticleTitleAortic value repair and replacement after balloon aortic valvuloplasty in children Ann Thorac Surg 61 1355–1358 Occurrence Handle10.1016/0003-4975(96)00018-5 Occurrence Handle1:STN:280:BymB3c7nsVw%3D Occurrence Handle8633940
D Health EH Wood JW DuShane JE Edwards (1959) ArticleTitleThe structure of the pulmonary trunk at different ages and in cases of pulmonary hypertension and pulmonary stenosis J Pathol Bacteriol 77 443–466
T Ishizaka EJ Devaney SR Ramsburgh et al. (2003) ArticleTitleValue sparing aortic root replacement for dilatation of the pulmonary autograft and aortic regurgitation after the Ross procedure Ann Thorac Surg 75 1518–1522 Occurrence Handle12735572
RC Jindal A Saxena R Juneja SS Kothari S Shrivastava (2000) ArticleTitleLong-term results of balloon aortic valvulotomy for congenital aortic stenosis in children and adolescents J Heart Valve Dis 9 623–628 Occurrence Handle1:STN:280:DC%2BD3cvovF2jsw%3D%3D Occurrence Handle11041174
JJ Lamberti (1996) ArticleTitleThe aortic valve: to dilate, repair or replace—that is the question Ann Thorac Surg 61 1297–1298 Occurrence Handle10.1016/0003-4975(96)00157-9 Occurrence Handle1:STN:280:BymB3c7ntl0%3D Occurrence Handle8633931
A Laudito MM Brook S Suleman et al. (2001) ArticleTitleThe Ross procedure in children and young adults: a word of caution J Thorac Cardiovasc Surg 122 147–153 Occurrence Handle10.1067/mtc.2001.113752 Occurrence Handle1:STN:280:DC%2BD3MznvFalsw%3D%3D Occurrence Handle11436048
R Moidl P Simon O Chevtchik et al. (2000) ArticleTitleDoes the Ross operation fulfill the objective performance criteria established for new prosthetic heart valves? J Heart Valve Dis 9 190–194 Occurrence Handle1:STN:280:DC%2BD3c3jt12ruw%3D%3D Occurrence Handle10772035
L Plank J James CA Wagenvoort (1979) ArticleTitleCaliber and elastic content of the pulmonary trunk Arch Pathol Exp Med 104 38–245
HJA Rimoldi M Lev (1963) ArticleTitleA note on the concept of normality and abnormality in quantitation of pathologic findings in congenital heart disease Pediatr Clin North Am 10 589–591
DN Ross (1967) ArticleTitleReplacement of the aortic root and mitral valves with pulmonary autograft Lancet 2 956–958 Occurrence Handle1:STN:280:CCeD3cngs1Q%3D Occurrence Handle4167516
P Simon C Ashauer R Moidl et al. (2001) ArticleTitleGrowth of the pulmonary autograft after the Ross operation in childhood Eur J Cardiothorac Surg 19 118–121 Occurrence Handle10.1016/S1010-7940(00)00638-2 Occurrence Handle1:STN:280:DC%2BD3M3lsl2muw%3D%3D Occurrence Handle11167098
L Solymar G Sudow D Holmgren (2000) ArticleTitleIncrease in size of the pulmonary autograft after the Ross operation in children: growth or dilatation? J Thorac Cardiovasc Surg 19 118–121
J Wada M Yokohama A Hashimoto et al. (1980) ArticleTitleLong term follow-up of artificial valves in patients under 15 years old Ann Thorac Surg 29 519–521 Occurrence Handle1:STN:280:Bi%2BB3MbhtV0%3D Occurrence Handle7387244
DB Williams DK Danielson DC McGoon et al. (1982) ArticleTitlePorcine heterograft valve replacement in children J Thorac Cardiovasc Surg 84 446–450 Occurrence Handle1:STN:280:Bi2B2s%2FlsF0%3D Occurrence Handle7109674
Acknowledgment
We thank Dr. Aldo Castañeda for reviewing the manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Vida, V., Rubino, M., Bottio, T. et al. Performance of the Pulmonary Autograft in Four Infants After the Ross Procedure. Pediatr Cardiol 26, 797–800 (2005). https://doi.org/10.1007/s00246-005-0938-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-005-0938-z