HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Giovanni Battista Luciani Francesca Viscardi Alessandro Mazzucco Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Luciani, G. B. Articles by Mazzucco, A. Search for Related Content PubMed PubMed Citation Articles by Luciani, G. B. Articles by Mazzucco, A. Related Collections Valve disease

J Thorac Cardiovasc Surg 2004;128:753-756
© 2004 The American Association for Thoracic Surgery

Brief communication

Valve-sparing root replacement for pulmonary autograft dissection late after the Ross operation

^a Division of Cardiac Surgery, University of Verona, Verona, Italy

Received for publication February 10, 2004; revisions received March 5, 2004; accepted for publication March 15, 2004.

^* Address for reprints: Giovanni Battista Luciani, MD, Division of Cardiac Surgery, University of Verona, O. C. M. Piazzale Stefani 1, Verona, 37126 Italy
gbluciani@yahoo.com

The first 300 words of the full text of this article appear below.

Aortic valve replacement with the pulmonary autograft (ie, the Ross operation) is generally associated with satisfactory early and late results. Complications, however, can occur, including the tendency of the pulmonary autograft root to dilate with time.¹ Whereas neoaortic root dilatation might be observed in as many as one third of patients late after the Ross operation,² uncertainty still exists as to the rate of progression toward true aneurysmal disease (aortic diameter 5 cm).^1,2 Furthermore, the actual risk of complications, such as neoaortic rupture or dissection, is also unknown. The yet undefined natural history of root dilatation after the Ross operation, the often satisfactory competence of the pulmonary autograft valve, the scarcity of valid therapeutic alternatives (particularly in the infant and child), and the complexity–risk of reintervention have thus far delayed standardization of therapeutic indications. In particular, timing and technique of reoperation on the aneurysmal neoaortic root are still controversial.^1,2

Here we present a case of potentially lethal evolution of progressive pulmonary autograft dilatation (ie, neoaortic root dissection) successfully treated with valve-sparing root replacement. The implications in terms of natural history and indications for reintervention are discussed.

Clinical summary

A 29-year-old man with a long-standing history of aortic valve regurgitation on the bicuspid aortic valve and mild dilatation of the aortic root underwent elective aortic root replacement with the pulmonary autograft on October 18, 1994. The right ventricular outflow tract was reconstructed with a 28-mm pulmonary homograft. Postoperative recovery was uneventful, and discharge echocardiography showed competent semilunar valves and normal aortic root diameter. Two years after the operation, moderate dilatation of the aortic root (maximum diameter, 46 mm) was identified at yearly echocardiographic examination. The aortic valve, however, was competent, and the patient was completely symptom free. Subsequent examinations confirmed progressive root dilatation, which reached true aneurysmal dimensions 8 years after the operation. . . . [Full Text of this Article]