J Thorac Cardiovasc Surg 1994;107:1164
© 1994 Mosby, Inc.
Invited letter concerning: Accelerated degeneration of aortic allografts in infants and young children
Ricardo Gallo, MD,
Naresh Kumar, FRCS,
Ganga Prabhakar, FRCS,
Zohair Al-Halees, FRCSC,
Carlos M. G. Duran, MD, PhD
Department of Cardiovascular Diseases
King Faisal Specialist Hospital and Research Centre
Riyadh 11211, Saudi Arabia
Reply to the Editor:
We concur with Dr. Clarke's opinion that early fibrocalcific degeneration of the aortic allograft in infants warrants a critical reevaluation of this conduit in left ventricular outflow tract anomalies.
Pulmonary autograft transplantation (Ross procedure) is our preferred choice for aortic root anomalies whenever the anatomy is suitable in infants and children. 
1 We have performed 30 Ross procedures since 1991 in children under 18 years of age. 2 This was not an option in this particular case because of the truncal anatomy. In two infants with aortic allografts in the right ventricular outflow tract, we have empirically prescribed low-dose cyclosporine to obviate immunologic responses. These children are doing well at 3 and 2 months without any echocardiographic evidence of fibrocalcific degeneration. Critical long-term follow-up of their conduits, along with the wider experience of Dr. Clarke with homografts in the aortic position, would be necessary to validate this immunologic theory of degeneration.
References
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Harfi HA, Qadri SMN, Frayha H, Halees Z, Wilson N, Malik S. Successful treatment of endocarditis and aortic root abscess due to Candida tropicalisin a young child. Curr Ther Res 1991;50:396-401.
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Al-Halees Z, Kouqeer F, Galal O, Fadley F, Al-Sanei A, Duran C. Aortic valve replacement utilizing the pulmonary autograft (the Ross procedure) in the young (abstract). Presented at a meeting of the World Congress of Pediatric Cardiology and Cardiac Surgery, Paris, June 21-25, 1993.
