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

[tdmartin2000 at aol.com]

Carmi
The dissection is really variable in these types of cases with some being relatively easy and some terribly difficult. I would most likely opt for replacement of the aorta down to the annulus almost like a David, or even consider an external sleeve like we do with the Florida sleeve procedure and then replacing the valve as usual. That way when you come back in 10 to 15 yrs all you have to do is drop a valve down inside, instead of another root. I personally like the Mosaic porcine valves but a pericardial would work also. On the pulmonary side I would probable look at using a Freestyle and making it so? it wouldn't be difficult there either when you come back.

Tom Martin
U of Florida
Gainesville


-----Original Message-----
From: Cysmd613 at aol.com
To: OpenHeart-L at lists.hsforum.com
Sent: Thu, 6 Sep 2007 1:00 am
Subject: [HSF] AI and ASC AO Aneurysm s/p Ross procedure



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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