Abstract
Aim: The indications for aortic root replacement in pediatric patients include (1) ascending aorta aneurysm with a congenital aortic wall defect combined with annuloectasy and aortic valve regurgitation, and (2) acquired severe aortic valve regurgitation following valvuloplasty of a critical aortic stenosis with a hypoplastic aortic annulus making implantation of the smallest valve prosthesis impossible. The study reports the authors own experience with aortic valve replacement in children with human aortic homografts or pulmonary autografts using the Ross procedure.
Material and methods: In the 1992-1999 period, aortic valve replacement was performed in 12 children aged 5 days-12 years in the Pediatric Heart Center of the Prague-based Motol University Hospital. In four children, the indication was ascending aorta aneurysm with severe aortic regurgitation.
The aortic root was replaced by an aortic homograft 23-27 mm in diameter. Eight children had aortic regurgitation ever since birth; in seven cases, the condition was acquired following balloon valvuloplasty of a critical aortic stenosis.
In these pediatric patients, the aortic root was replaced by a pulmonary autograft 10-19 mm in diameter using the Ross procedure. Results: One child (with Marfans syndrome and a solitary left coronary artery) died after aortic root replacement using a homograft.
The other patients are free of clinical problems and are doing well. Aortic regurgitation disappeared in 10 children.
The aortic annulus grows after the Ross procedure in all 5 children examined 9-30 months after surgery. One patient developed progressive extreme left ventricular hypertrophy with unobstructed outflow tract.
Conclusion: Human valves as aortic homografts or pulmonary autografts are suitable for aortic valve replacement in children. In small children with a narrow aortic annulus, aortic root replacement with a pulmonary autograft using the Ross procedure is not only the method of choice but, in fact, also the only option.
A new technique of exchange of aortic and pulmonary valves following some modification of the originally regurgitating aortic valve has been developed as an alternative in older pediatric patients.