CASE REPORTS  CARDIAC PAPERS 

The Journal of Cardiovascular Surgery 2000 June;41(3):387-92

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Ross procedure for complex left ventricular outflow tract obstruction

Wilson W. R., Greer G. E., Durzinsky D. S., Curtis J. J.

From the Division of Cardiothoracic Surgery and the Department of Child Health University of Missouri Health Sciences Center, Columbia, Missouri, USA The Division of Cardiothoracic Surgery Medical College of Ohio, Toledo, Ohio, USA

Background. Complex ­left ven­tric­u­lar out­flow ­tract (LVOT) obstruc­tion in chil­dren con­tin­ues to ­pose a sig­nif­i­cant ther­a­peu­tic chal­lenge to car­diac sur­geons. The Ross pro­ce­dure, in com­bi­na­tion ­with resec­tion of sub­aor­tic sten­o­sis or a Konno ­type sep­tal inci­sion, is an impor­tant ­option for ­these dif­fi­cult ­patients.
Methods. Recently two chil­dren ­aged 14 and 5 ­years ­with ­LVOT obstruc­tion involv­ing com­bined sub­aor­tic and val­var sten­o­sis under­went sur­gi­cal cor­rec­tion ­using the pul­mo­nary auto­graft. Clinical pres­en­ta­tion, oper­a­tive tech­nique, out­come and inter­me­di­ate fol­low-up are ­detailed.
Results. One ­patient had resec­tion of an iso­lat­ed subaor­tic mem­brane in com­bi­na­tion ­with a pul­mo­nary auto­graft and the sec­ond a Ross Konno pro­ce­dure. Postoperative hos­pi­tal ­stays ­were with­out com­pli­ca­tion. Both ­patients ­were dis­charged at 5 ­days and ­have no sig­nif­i­cant obstruc­tion nor sem­i­lu­nar ­valve insuf­fi­cien­cy at 3 ­years’ fol­low-up.
Conclusions. Pulmonary auto­grafts can be ­used in com­bi­na­tion ­with resec­tion of sub­aor­tic tis­sue or a sep­tal inci­sion for recon­struc­tion of com­plex ­left ven­tric­u­lar out­flow ­tract obstruc­tion. This tech­nique ren­ders excel­lent ­short ­term ­valve func­tion, ­relief of obstruc­tion, ­avoids anti­co­ag­u­la­tion and pro­vides poten­tial for ­future ­growth.