Aortic valve replacement in young patients has its problems. Biologic prosthetic valves degenerate and need replacement. Metalic prosthetic valves are more durable, however, anticoagulation which has its inherent problems is inevitable. The use of Ross procedure in young patients is gaining wider acceptance. The need of foreign pulmonary valve in right ventricular outflow tract (RVOT) will require reoperation due to RVOT obstruction, later. To overcome this problem, we reimplanted the native aortic valve in the pulmonary position in 21 year old female patient operated on utilizing the Ross procedure for aortic insufficiency. We experienced that the diseased aortic valve worked well in the pulmoanry position because of low pulmonary artery pressure and resistance.
Aortic Valve* ; Female ; Humans ; Pulmonary Artery ; Pulmonary Valve* ; Reoperation ; Transplantation, Autologous ; Young Adult

BACKGROUND: The function of a bioprosthetic heart valve is determined largely by the material properties of the valve cusps. The uniaxial tensile test has been studied extensively. This type of testing, however, does not replicate the natural biaxial loading condition. The objective of the present study was to investigate the regional variability of the biaxial strain versus pressure relationship based on the types of fixation liquid models. MATERIAL AND METHOD: Porcine aortic valves and pulmonary valves were assigned to three groups: the untreated fresh group, the fixed with glutaraldehyde (GA) group, and the glutaraldehyde with solvent (e.g., ethanol) group. For each group we measured the radial and circumferential stretch characteristics of the valve as a function of pressure change. RESULT: Radial direction elasticity of porcine aortic and pulmonary valves were better than circumferential direction elasticity in fresh, GA fixed, and GA+solvent fixed groups (p=0.00). Radial and circumferential direction elasticity of pulmonary valves were better than aortic valves in GA fixed and GA+solvent fixed groups (p=0.00). Radial and circumferential direction elasticity of aortic valves were decreased after GA and GA+solvent fixation (p=0.00), except for circumferential elasticity of GA+solvent fixed valves (p=0.785). The radial (p=0.137) and circumferential (p=0.785) direction of elasticity of aortic valves were not significantly different between GA fixed and GA+solvent fixed groups. Radial (p=0.910) and circumferential (p=0.718) direction of elasticity of pulmonary valve also showed no significant difference between GA fixed and GA+solvent fixed groups. CONCLUSION: When fixing porcine valves with GA, adding a solvent does not cause a loss of mechanical properties, but, does not improve elasticity either. Radial direction elasticity of porcine aortic and pulmonary valves was better than circumferential direction elasticity.
Aortic Valve ; Elasticity ; Glutaral ; Heart Valves ; Pulmonary Valve ; Sprains and Strains ; Transplantation, Heterologous

OBJECTIVETo summarize the experience on auto-pulmonary transplantation (Ross procedure) treating with congenital aortic disease.

METHODSFrom October 1994 to November 2003, 20 cases of Ross procedure were performed to treat with congenital aortic disease, Male: 15 cases; Female: 5 cases; age: 25 years;

DIAGNOSIScongenital heart disease (CHD), aortic abnormalities: 12 cases; aortic valve prolapse: 5 cases; aortic valve hypogenesis: 3 cases; combined with subacute bacterial endocarditis (SBE): 4 cases, and ventricle septal defect (VSD): 2 cases; UCG showed aortic stenosis(AS) and/or aortic insufficience (AI) (moderate to severe), Left ventricle diastole diameter (LVDD): (60.51 +/- 11.87) mm, the grade pressure across aortic valve: (27.04 +/- 6.80) mmHg, heart function (NYHA): Class II: 13 cases; Class III: 3 cases; all cases were performed under CPB and moderate hypothermia, the operation procedure was following: (1) taking off auto-pulmonary artery valve; (2) removing dysfunctional aortic valve and auto-transplantation of pulmonary valve on aortic root; (3) putting a pulmonary homograft to rebuild right ventricular outflow tract.

RESULTSThe mortality was 0 during stay at hospital, aortic valve function were all normal, LVDD decreased significantly (t = 3.4007, P = 0.0008), the grade pressure across aortic valve was in normal limitation, (6.8 +/- 0.19) mmHg. Follow-up showed heart function was in Class I (NYHA), aortic and pulmonary valve function was very well.

CONCLUSIONRoss procedure is a kind of effective alterative operation for treating with congenital aortic valve disease, with good short and middle term results.

Adolescent ; Adult ; Aortic Valve Insufficiency ; surgery ; Aortic Valve Prolapse ; surgery ; Aortic Valve Stenosis ; surgery ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Male ; Pulmonary Valve ; transplantation ; Transplantation, Autologous

BACKGROUND: Ross procedure is the pulmonary valve autograft in the aortic valve disease, and its use trends to increase after introduced by Ross in 1967, firstly. The most important point is that it is a permanent valve replacement. It is to be ideal method to the young patient because the graft is a viable tissue to be able to grow, and hemodynamically, most similar to the normal aortic valve, and doesn't need to do anticoagulation therapy due to not having the thromboembolism, but not popular because it has a lot of technical problem and doesn't have the long-term follow-up METHODS: The patients were 8 admitted between October 1997 and October 1998, the age from 15 to 39 ; 6 males and 2 females. The causes of disease were 4 patients of rheumatic disease, 1 of a infective endocarditis with the aortic annular abscess,1 of recurred severe aortic insufficiency 2 years after replacement. Two patients used the homograft and 6 patients switched a diseased aortic valve with the pulmonary autograft. RESULTS: There were no death and the preoperative dyspnea nearly disappeared (NYHA FC III-IV -> I-II). The diastolic diameter of left ventricle decreased significantly when we compared to the previous echocardiography 1 month after the operation, and we observed the mild aortic valve insufficiency in 3 patients, severe in 4, mild pulmonary valve insufficiency in 4, severe in 1, and mild pulmonary valve stenosis in 4. CONCLUSION: The operative death rate of Ross procedure in the aortic valve disease was not higher than the artificial valve replacement. Therefore, if we find the appropriate indication of operation, we can expect better results and think that we should have the long-term follow-up furthermore.
Allografts ; Aortic Valve ; Aortic Valve Insufficiency ; Autografts* ; Dyspnea ; Echocardiography ; Endocarditis ; Female ; Follow-Up Studies ; Heart Ventricles ; Humans ; Male ; Mortality ; Pulmonary Valve ; Pulmonary Valve Insufficiency ; Pulmonary Valve Stenosis ; Rheumatic Diseases ; Thromboembolism ; Transplantation, Autologous ; Transplants

The Ross operation, a procedure of replacement of the diseased aortic valve with an autologous pulmonary valve, has many advantages such as no need for anticoagulation therapy and similar valve function and growth potential as native valves. However secondary aortic disease has emerged as a significant complication and indication for reoperation. We report a 48-year-old woman who had Ross operation in 1997 for a damaged bicuspid aortic valve and severe aortic regurgitation due to subacute bacterial endocarditis complicated by aortic root abscess. In 2009, 12 years later, progressive severe aortic regurgitation with incomplete coaptation and mild dilatation of the aortic root was shown on echocardiography and contrasted CT, while the pulmonary homograft retained normal function. She subsequently underwent aortic valve replacement. Histopathological examination of the explanted neo-aortic valve and neo-arterial wall revealed pannus formation at the nodulus Arantii area of the three valve cusps, ventricularis, and arterialis. The amount of elastic fibres in the neo-aorta media was less than usual for an aorta of this patient's age but was similar to a pulmonary artery. The pathological findings were not different from other studies of specimens removed between 7 to 12 years after Ross operation. However, the pathophysiology and long-term implications of these findings remain debatable. Considering the anatomical and physiological changes induced by the procedure, separate mechanisms for aortic dilatation and regurgitation are worthy of consideration.
Aorta/*pathology ; Aortic Valve/*surgery ; Aortic Valve Insufficiency/*etiology ; Cardiovascular Surgical Procedures/*adverse effects ; Dilatation, Pathologic ; Heart Valve Diseases/*surgery ; Prostheses and Implants ; Pulmonary Valve/*transplantation

BACKGROUNDAortic root replacement with pulmonary autograft (Ross procedure) has the advantages of good haemodynamics and growth potential without the need for anticoagulation. In this study, we reviewed our experience of the Ross procedure for patients with aortic valve disease.

METHODSFrom October 1994 to January 2005, 42 Ross procedures were performed in our centre. There were 30 males and 12 females. The mean age was 28 +/- 15 years (range, 5-56 years). Congenital heart disease (CHD) with aortic valve stenosis (AS) and/or aortic valve insufficiency (AI) in 40 cases including one associated with ventricular septal defect (VSD), degenerated aortic valve disease with AS in 1 and subacutive bacterial endocarditis (SBE) with AI in 1 were studied. The diagnosis was made by ultracardiography (UCG) in all patients. The mean aortic valve annulus diameter (AVD) was (2.45 +/- 0.31) cm and pulmonary valve annulus diameter (MPVD) was (2.34 +/- 0.21) cm. All patients had normal pulmonary valves. The New York Heart Association (NYHA) function class was II in 36 cases and III in 6 cases. The operation was performed under moderate hypothermic cardiopulmonary bypass (CPB) with aortic root replacement using pulmonary autograft and pulmonary valve replacement with a homograft.

RESULTSThere was no early hospital mortality. Postoperative UCG showed normal aortic valve function in all our patients. The mean gradient across the aortic valve was (6.11 +/- 0.12) mmHg. The left ventricular diastole diameter (LVDD) decreased significantly from (62 +/- 5) mm to (56 +/- 3) mm (P < 0.001). The mean postoperative left ventricular ejective fraction (LVEF) was 0.49 +/- 0.23. All patients were in NYHA class I-II. Follow-up was completed in 38 cases for a mean period of 3.2 years (range 1-10 years). All survivors were in NYHA class I with normal neo-aortic and pulmonary valve function. One patient died after secondary operation due to homograft fungal endocarditis 1 year after the Ross procedure. The cause of death was uncontrolled bleeding. Another patient suffered from cardiogenic shock and was on extracorporeal membrane oxygenation (ECMO) for 10 days postoperatively. This patient was subsequently self-discharged from hospital due to financial issues and he was excluded from follow-up.

CONCLUSIONThe Ross procedure is an excellent technique to treat aortic valve disease. Our data show that it can be performed safely with good early and mid-term clinical outcomes.

Adolescent ; Adult ; Aortic Valve Insufficiency ; surgery ; Aortic Valve Stenosis ; surgery ; Child ; Child, Preschool ; Female ; Humans ; Male ; Middle Aged ; Pulmonary Valve ; transplantation ; Transplantation, Autologous

We report a case of the isolation of the Aspergillus versicolor complex, initially misidentified by morphological characteristics as the Scopulariopsis species, from a homograft with a bicuspidalized pulmonary valve. An eighteen-month-old female, who had critical pulmonary stenosis, underwent pulmonary valve replacement. On postoperative day 8, she developed a fever, which did not respond to empiric broad-spectrum antibiotics. While no definitive source was identified, a filamentous fungus was isolated from the thawed homograft tissue culture prior to implantation on the operation day. The colonies were powdery green with white edges on Sabouraud dextrose agar. Microscopic examination showed septate hyphae with branched conidiophores and chains of spiny conidia, which suggested Scopulariopsis species. After direct sequencing of the internal transcribed spacer (ITS) regions, the fungus was identified as the A. versicolor complex. To our knowledge, the isolation of the A. versicolor complex from a homograft valve has not been previously described. This case shows that laboratory staff should be aware that microscopic morphology of the A. versicolor complex can resemble that of a number of other genera, including Scopulariopsis species.
Agar ; Anti-Bacterial Agents ; Aspergillus ; Bicuspid ; European Continental Ancestry Group ; Female ; Fever ; Fungi ; Glucose ; Humans ; Hyphae ; Pulmonary Valve ; Pulmonary Valve Stenosis ; Scopulariopsis ; Spores, Fungal ; Transplantation, Homologous

BACKGROUND: Various experimental trials for the development of bioprosthetic devices are actively underway, secondary to the limited supply of autologous and homograft tissue to treat cardiac diseases. In this study, porcine bioprostheses that were treated with glutaraldehyde (GA), ethanol, or sodium dodecylsulfate (SDS) were examined with light microscopy and transmission electron microscopy for mechanical and physical imperfections before implantation. MATERIAL AND METHOD: 1) Porcine pericardium, aortic valve, and pulmonary valve were examined using light microscopy and JEM-100CX II transmission electron microscopy, then compared with human pericardium and commercially produced heterografts. 2) Sections from six treated groups (GA-Ethanol, Ethanol-GA, SDS only, SDS-GA, Ethanol-SDS-GA and SDS-Ethanol-GA) were observed using the same methods. RESULT: 1) Porcine pericardium was composed of a serosal layer, fibrosa, and epicardial connective tissue. Treatment with GA, ethanol, or SDS had little influence on the collagen skeleton of porcine pericardium, except in the case of SDS pre-treatment. There was no alteration in the collagen skeleton of the porcine pericardium compared to commercially produced heterografts. 2) Porcine aortic valve was composed of lamina fibrosa, lamina spongiosa, and lamina ventricularis. Treatment with GA, ethanol, or SDS had little influence on these three layers and the collagen skeleton of porcine aortic valve, except in the case of SDS pre-treatment. There were no alterations in the three layers or the collagen skeleton of porcine aortic valve compared to commercially produced heterografts. CONCLUSION: There was little physical and mechanical damage incurred in porcine bioprosthesis structures during various glutaraldehyde fixation processes combined with anti-calcification or decellularization treatments. However, SDS treatment preceding GA fixation changed the collagen fibers into a slightly condensed form, which degraded during transmission electron micrograph. The optimal methods and conditions for sodium dodecylsulfate (SDS) treatment need to be modified.
Aortic Valve ; Bioprosthesis ; Collagen ; Connective Tissue ; Electrons ; Ethanol ; Glutaral ; Heart Diseases ; Humans ; Light ; Microscopy ; Microscopy, Electron ; Microscopy, Electron, Transmission ; Pericardium ; Pulmonary Valve ; Skeleton ; Sodium ; Transplantation, Heterologous ; Transplantation, Homologous

BACKGROUND: Since Ross and Sormeville first reported the use of aortic homograft valve for correction of pulmonary atresia in 1966, homograft valves are widely used in the repair of congenital anomalies as conduits between the pulmonary ventricle and pulmonary arteries. On the basis of these results, we have used it actively. In this report, we describe our experience with the use of cryopreserved valved homograft conduits for infants and children requiring right ventricle to pulmonary artery connection in various congenital cardiac anomalies. MATERIAL AND METHOD: Between January,1996 and December 2001, 27 infants or children with a median age of 16 months(range 9days to 18years) underwent repair of RVOTO using homograft valved conduit by two surgeons. We studied 22 patients who have been followed up at least more than one year. The diagnosis at operation included pulmonary atresia with ventricular septal defect (n=13), truncus arteriosus (n=3), TGA or corrected TGA with RVOTO (n=6). Homograft valved conduits varied in size from 15 to 26 mm (mean, 183.82 mm). The follow-up period ranged from 12 to 80.4 months (median, 48.4 months). RESULT: There was no re-operation due to graft failure itself. However, early progressive pulmonary homograft valve insufficiency developed in one patient, that was caused by dilatation secondary to the presence of residual distal pulmonary artery stenosis and hypoplasia after repair of pulmonary atresia with ventricular septal defect. This patient was required reoperation (conduit replacement). During follow-up period, there were significant pulmonary stenosis in one, and pulmonary regurgitation more than moderate degree in 3. And there were mild calcifications at distal anastomotic site in 2 patients. All the calcified homografts were aortic in origin. CONCLUSION: We observed that cryopreserved homograft conduits used in infant and children functioned satisfactorily in the pulmonic position at mid-term follow-up. To enhance the homograft function, ongoing investigation is required to re-establish the optimal strategy for the harvest, preservation and the use of it.
Allografts ; Child ; Constriction, Pathologic ; Cryopreservation ; Diagnosis ; Dilatation ; Follow-Up Studies* ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Humans ; Infant ; Pulmonary Artery ; Pulmonary Atresia ; Pulmonary Valve Insufficiency ; Pulmonary Valve Stenosis ; Reoperation ; Transplantation, Homologous ; Transplants ; Truncus Arteriosus

BACKGROUND: Conventional cardiac transplantation with each atrial anastomosis designed by Shumway and associates has been used widely in cardiac transplantation because of its simplicity and efficiency. There have been many reports about the postoperative atrioventricular value regurgitation resulting from the alteration in atrial geometry after cardiac transplantation by Shumway's technique. New surgical technique of direct anastomosis of superior vena cava, inferior vena cava, right pulmonary vein and left pulmonary vein was introduced to overcome the those problems. We performed this study to test the feasibility of this new surgical technique prior to application to clinical practice. MATERIAL AND METHOD: Conventional cardiac transplantation was performed on 12 mongrel dogs(Group I) and cardiac transplantation with new surgical mthod of direct anastomosis of SVC, IVC, left and right pulmonary veins was performed on 11 mongrel dogs(Group II). After weaning from cardiopulmonary bypass, we compared the postoperative rhythm, hemodynamic data, and echocardiographic findings between two groups. RESULT: The cardiopulmonary bypass time and graft ischemic time were 119.0+/-4.4 minutes, 162.0+/-4.5 minutes respectively in group I, and 140.0+/-7.1 minutes, 180.5+/-5.4 minutes respectively in group II. The cardiopulmonary time and graft ischemic time in group II were longer than those of group I (p<0.05). There were 3 cases of failure to weaning from cardipulmonary bypass onein group I and two in group II, and this difference was not significant statistically. Sinus rhythm was regained postoperatively in 58% (group I) and 82%(group II), without statistical significant between 2 groups. Postoperative echolcardiography showed 2 cases of tricuspid value regurgitation and 1 case of mitral regurgitation in group I, and no regurgitation of atrioventricular value in group II. CONCLUSIONS: Although these was no statistically significant difference between 2 groups, there was tendency of less arrhythmia and less atrioventricular valvular regurgitation in group II. We suggested that the new surgical technique could be a useful strategy in heart transplantation, especially in the case of size mismatching between donor and recipient.
Animals ; Arrhythmias, Cardiac ; Cardiopulmonary Bypass ; Dogs* ; Echocardiography ; Heart Transplantation* ; Heart* ; Hemodynamics ; Humans ; Mitral Valve Insufficiency ; Pulmonary Veins ; Tissue Donors ; Transplants ; Vena Cava, Inferior ; Vena Cava, Superior ; Weaning