[HSF] AI and ASC AO Aneurysm s/p Ross procedure

[Cysmd613 at aol.com]

I would like to get the Forum's opinions and advice concerning an interesting 
patient referred to me.
 
44 yo male who underwent Ross Procedure in 1995 (pulmonary homograft used to 
replace PV and prox PA) for a 6cm ascending aortic aneurysm and bicuspid 
aortic valve.  According to the op report, he did not have AI pre op.  
Recently he has been having some dyspnea on exertion and decreased stamina 
(he used to surf for 4 to 5 hours a day, now he can only last about 1.5 hours).  
An echo showed moderate to severe AI, a 5.5 cm aortic root, and a significant 
gradient across the pulmonic valve.
Appears that he needs redo aortic root replacement and pulmonic valve 
replacement.
In your experience, how difficult is the dissection after a Ross procedure, 
as I haven't had the pleasure of operating on a patient who has had a prior 
Ross.  
This patient does not wish a mechanical valve, so I would plan to use 
pericardial valves.
 
Thank you in advance for your responses.
 
Carmi Stadlan



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