Extending the limits of the Ross procedure.
BACKGROUND
The potential for growth and the proven long-term durability of the native pulmonary valve make it ideal for replacement of the diseased aortic valve, especially in growing children. The use of the autologous pulmonary valve can be further extended to patients with complex left ventricular outflow tract obstruction and to neonates and infants.


METHODS
Between June 1993 and May 1995, 35 patients underwent the Ross procedure at our center. Of these, 15 (43%) had complex left ventricular outflow tract obstruction and 7 (20%) were infants, including 3 neonates. The autologous pulmonary valve was implanted as a root replacement with coronary reimplantation in all patients. Additional left ventricular outflow tract procedures performed were ventricular myectomy in 7 patients and a Konno type aortoventriculoplasty in 11 patients.


RESULTS
There was one early death in a patient with borderline hypoplastic left heart syndrome. At a median follow-up of 9 months (range, 0.2 to 22 months) there were no late deaths or reinterventions. The autologous pulmonary valve function was excellent, with 1 (2.8%) patient having moderate insufficiency.


CONCLUSIONS
Autologous pulmonary valve is an excellent option for aortic valve replacement in all age groups. Its use can be readily extended to neonates, infants, and patients with complex left ventricular obstruction requiring additional left ventricular outflow tract procedures.
Reddy
V M
VM
Division of Cardiothoracic Surgery, University of California, San Francisco 94143-0118, USA.
Rajasinghe
H A
HA
McElhinney
D B
DB
van Son
J A
JA
Black
M D
MD
Silverman
N H
NH
Hanley
F L
FL
D000293:Adolescent; D000328:Adult; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011664:Pulmonary Valve / Q000637:transplantation*; D014694:Ventricular Outflow Obstruction / Q000601:surgery