Type A Aortic Dissection After the Ross Procedure.

Area of Science:

• Cardiovascular Surgery
• Cardiology
• Aortic Diseases

Background:

• The Ross procedure, involving aortic valve replacement with the patient's own pulmonary valve, is a complex surgical option for aortic valve endocarditis.
• Pregnancy can place significant hemodynamic stress on the cardiovascular system, potentially exacerbating pre-existing aortic conditions.
• Type A aortic dissection is a life-threatening condition involving the ascending aorta.

Observation:

• A 25-year-old woman, 13 years post-Ross procedure for aortic valve endocarditis, presented with aortic root enlargement during late pregnancy.
• Postpartum echocardiography revealed new aortic valve insufficiency and a 6.5 cm aortic root diameter.
• Computed tomography angiography confirmed a type A aortic dissection confined to the proximal ascending aorta.

Findings:

• Intraoperative findings indicated the dissection was limited to the pulmonary autograft used in the prior Ross procedure.
• A successful valve-sparing repair of the dissected pulmonary autograft was performed.
• The patient experienced an uneventful postoperative recovery.

Implications:

• This case highlights the potential for late aortic complications, including dissection, in patients with a history of the Ross procedure, particularly during pregnancy.
• Valve-sparing techniques can be effective in managing dissections involving the pulmonary autograft.
• Long-term surveillance is crucial for patients who have undergone the Ross procedure, especially those with aortic root dilation or pregnancy history.