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Updated: Aug 15, 2026
A Rodent Model of The Ross Operation: Syngeneic Pulmonary Artery Graft Implantation in A Systemic Position
Published on: April 1, 2022
Performance of the pulmonary autograft in four infants after the Ross procedure
1Department of Pediatric Cardiac Surgery, University of Padova Medical School, Padova, 35128, Italy. vladimirovida@interfree.it
Insights
The Ross operation using pulmonary autografts (PAG) shows good initial results in infants. However, mid-term follow-up reveals significant increases in PAG dimensions, requiring close monitoring.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Congenital Heart Disease
Background:
- Pulmonary autografts (PAG) are effective aortic valve substitutes in pediatric patients.
- The Ross operation is a viable surgical option for infants with unsuitable aortic valve anatomy.
Purpose of the Study:
- To evaluate the performance and growth adaptation of pulmonary autografts (PAG) in the systemic position in infants.
- To compare PAG growth to healthy controls to assess adaptation to systemic pressure.
Main Methods:
- Four infants underwent the Ross operation between April 1998 and January 2000.
- Postoperative echocardiograms monitored PAG function and dimensions.
- PAG growth was compared to matched healthy controls.
Main Results:
- No early deaths or reoperations; all patients were asymptomatic with stable hemodynamics.
- PAG annulus growth tracked body surface area without dilatation; mild regurgitation in three patients.
- Significant increases in PAG sinuses of Valsalva and sinotubular junction diameters observed mid-term.
Conclusions:
- The Ross operation in infants yields acceptable immediate surgical and hemodynamic outcomes.
- Mid-term enlargement of PAG sinuses and sinotubular junction necessitates ongoing surveillance.
Abstract:
Pulmonary valve autografts have proven to be valid aortic valve substitutes in children. The objective of this study is to evaluate the performance of the pulmonary autograft (PAG) in systemic position and its adjustment to growth in four infants who underwent a Ross operation. Between April 1998 and January 2000, four infants whose aortic valve anatomy and function were judged unsuitable for a valve-sparing operation underwent successful Ross operation. All patients were followed postoperatively with echocardiograms to evaluate the function and the dimensional changes of the PAG within the systemic circulation. The PAG adjustments to growth were compared to the growth of the pulmonary root of healthy patients matched for body surface area, with the purpose to evaluate the effects of the systemic pressure on the pulmonary vascular wall, as a passive dilatation process versus a true and active structural adaptation. Median follow-up was 53 months (range, 48-65). There were no early deaths or reoperations. All patients were asymptomatic and in stable hemodynamic conditions. The PAG annulus grew according to body surface area without dilatation. PAG valve regurgitation was present but mild in three patients. Trans-PAG peak gradients were not significant. The PAG diameter at the level of the sinuses of Valsalva and sinotubular junction increased rapidly and steadily in all patients during follow-up compared to controls. The Ross operation in infants provides acceptable immediate surgical and hemodynamic results. However, significant midterm increases in PAG sinuses and sinotubular junction diameters require close and continued observation.
