Ross procedure in an infant weighing 4.5 kg: eight years follow-up

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Congenital aortic stenosis presents a significant challenge in pediatric cardiac surgery.
• The Ross procedure, utilizing a pulmonary autograft, is a complex surgical option for aortic valve replacement.
• Right ventricular outflow tract (RVOT) reconstruction is often necessary in conjunction with aortic valve procedures.

Observation:

• A 6-month-old infant with congenital aortic stenosis underwent aortic valve replacement with a pulmonary autograft (Ross procedure).
• Initial RVOT reconstruction involved a polytetrafluoroethylene (PTFE)-valved equine pericardial conduit.
• At age 5, severe pulmonary stenosis necessitated re-RVOT reconstruction with a PTFE monocusp patch after failed percutaneous transluminal pulmonary valvotomy.

Findings:

• The pulmonary autograft demonstrated no functional deterioration at age 8.
• Aortic regurgitation was trivial at the 8-year follow-up.
• The patient experienced significant somatic growth without compromising the autograft function.

Implications:

• The Ross procedure can offer long-term functional benefits for aortic valve replacement in infants.
• Successful re-RVOT reconstruction is crucial for managing complications like pulmonary stenosis post-Ross procedure.
• This case highlights the durability of pulmonary autografts and the potential for managing complex pediatric congenital heart disease over time.