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[The Ross procedure in the acute phase of infectious endocarditis in childhood]
S Di Filippo1, A Bozio, G Champsaur
1Service de cardiologie C, hôpital Louis-Pradel, Lyon.
Insights
The Ross procedure using a pulmonary autograft is a safe and effective treatment for children with aortic valve infectious endocarditis, offering advantages over mechanical prostheses and homografts.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Infectious Diseases
Background:
- Infectious endocarditis in children can lead to severe aortic regurgitation requiring urgent valve replacement.
- Mechanical prostheses and homografts have limitations in pediatric patients, including risks of thrombosis, degeneration, and infection.
- The Ross procedure, using a pulmonary autograft, presents an alternative for aortic valve replacement in children.
Observation:
- Three pediatric patients with severe aortic valve infectious endocarditis underwent aortic valve replacement using the Ross procedure.
- All patients experienced rapid progression of aortic regurgitation, with complications including pulmonary edema and systemic emboli.
- Surgery was performed promptly, and postoperative recovery was uncomplicated, with no autograft dysfunction or stenosis noted on Doppler echocardiography.
Findings:
- The Ross procedure demonstrated favorable early outcomes in pediatric patients with infectious endocarditis.
- Advantages include no need for anticoagulation, potential for aortic ring growth, and low risk of degeneration and re-infection.
- Mortality rates were comparable to other techniques and lower than mechanical prostheses in endocarditis cases.
Implications:
- The Ross procedure appears to be a superior option for pediatric patients with complicated infectious endocarditis requiring acute aortic valve replacement.
- It offers a promising alternative with reduced long-term risks compared to traditional prosthetic valves.
- Further research with longer follow-up is warranted to confirm these encouraging findings.
Abstract:
The Ross procedure of aortic valve replacement with a pulmonary autograft has several advantages in childhood over mechanical prostheses or homografts, especially in infectious endocarditis requiring early surgery. Between January 1997 and July 1998, 3 children with no known previous cardiac disease, aged 14 months, 10 and 11 years, had aortic valve infectious endocarditis. The causal organism was not identified in 1 case and the other two were due to staphylococcus aureus and corynebacterium diphteriae. All children had severe, rapidly progressive aortic regurgitation complicated by pulmonary oedema in the baby and systemic emboli in the two older children. Surgery was performed within 9 days, 1.5 month and 2 months after the onset of the disease. The postoperative course was uncomplicated in the 3 cases. Postoperative Doppler echocardiography showed absence of autograft dysfunction or stenosis, with the presence of pulmonary regurgitation in 1 case. Pulmonary autograft has the advantages of not requiring anticoagulation, of allowing growth of the aortic ring, of not being limited by the age of the patient and of having a low risk of degeneration and infectious endocarditis. Therefore, it seems particularly indicated for cases of complicated infectious endocarditis requiring early aortic valve replacement. The early (4.8%) and late (4.3%) mortality rates were comparable to those of other techniques and are lower than those associated with valve replacement with mechanical prostheses in cases of endocarditis (8.5% versus 40%). The secondary morbidity is 18.8% with dysfunction of the autograft and/or stenosis of the pulmonary homograft. Despite a limited follow-up, aortic valve replacement by a pulmonary homograft seems better than aortic valve replacement with a homograft or mechanical prosthesis, especially in cases of complicated infectious endocarditis requiring surgery in the acute phase. Further studies are required to confirm these encouraging results.