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

[ichfno at aol.com]

We have done about 65 or so Ross procedures around the world, and the only one we have had to reoperate on for autograft failure was one where we used a dacron tube graft for the extension. At cath the dacron graft had a 55 mmHg gradient 4 years following operation. This gradient had been documented by echos, starting at about 9 months post original procedure, the discharge and 3 month follow-up echo's did not reveal a gradient. The autograft was extremely dialated and we replaced it with a Medtronic Freestyle and replaced the dacron as well. The reoperation was challenging, but not because of the autograft, because of the dacron. Although it is interesting to consider a David procedure, a 55 mm neo-aortic root might preclude this option. If you do not have significant experience with reoperative aortic root replacements this will be a real challenge. 


-----Original Message-----
From: psimha <prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Thu, 6 Sep 2007 6:41 am
Subject: Re: [HSF] AI and ASC AO Aneurysm s/p Ross procedure


Someone experienced with the David procedure could probably do this (Daunting with extensive scarring is to be expected). The RVOT can be patched if there is stenosis.?
Prasanna?
Cysmd613 at aol.com wrote:?
> 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?
>?
>?
>?
> ************************************** Get a sneak peek of the all-new AOL at > http://discover.aol.com/memed/aolcom30tour?
> _______________________________________________?
> OpenHeart-L mailing list?
>?
> Send postings to:?
> OpenHeart-L at lists.hsforum.com?
>?
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:?
> http://mmp.cjp.com/mailman/listinfo/openheart-l?
>?
> All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:?
> http://www.hsforum.com/listdisclaim?
> -----------------------------------------?
>?
>?
> ?
_______________________________________________?
OpenHeart-L mailing list?
?
Send postings to:?
OpenHeart-L at lists.hsforum.com?
?
To UNSUBSCRIBE, to CHANGE email address, or to view archives:?
http://mmp.cjp.com/mailman/listinfo/openheart-l?
?
All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at:?
http://www.hsforum.com/listdisclaim?
-----------------------------------------?


________________________________________________________________________
Email and AIM finally together. You've gotta check out free AOL Mail! - http://mail.aol.com