The Ross Procedure
Mr. Donald N. Ross, D.Sc., F.R.C.S.; Consultant Surgeon, National Heart Hospital, London, England
Mark W. Turrentine, M.D.; Assistant Professor, Cardiothoracic Surgery, University of Indiana
John W. Brown, M.D.; Harris B. Schumacker Professor of Surgery, Chief of Cardiothoracic Surgery, University of Indiana
Mark M. Levinson, M.D.; Hutchinson Hospital, Hutchinson, Kansas, USA
Ross Procedure Sections: Introduction | History | Anatomy | Pros & Cons | Patient Selection | Technique | Results | Pediatric Ross
The native aortic valve provides an crucial safety barrier for the important, high pressure left heart. In situations where the aortic valve is diseased or degenerated, serious pathology and symptoms occur. If left uncorrected, heart failure and death will eventually ensue. A normally functioning aortic valve is essential for life.
Diseases of the aortic valve can vary from mild congenital malformations such as a minor change in the leaflets all the way to serious valve destruction secondary to invasive infection. Regardless of the type of aortic valve pathology, great strain on the left ventricle (the main pumping chamber of the heart) often occurs as aortic valve function declines.
Briefly, there are two major problems which can occur to the aortic valve. The first, and most common is stenosis. This term implies the valve will not open, and the widest opening available for blood flow is simply too small. In simplistic terms, the valve is obstructive. The heart muscle must thicken and enlarge in order to force an adequate volume of blood through the narrowed valve. As it compensates for the valve stenosis, permanent or nearly permanent changes in the heart muscle occur. As time progresses, the thickening of the heart muscle gets worse, the pressure inside the heart chamber reaches intolerable levels, and congestion (fluid build up in the lungs) occurs, along with many other symptoms. Untreated aortic stenosis (A.S.) is associated with reduced quality and length of life.
If the leaflets of the valve do not seal properly, leakage occurs. This puts additional strain on the pumping chamber below. As blood is ejected out to the body, some returns to the pumping chamber via the leaking aortic valve. This condition is called aortic regurgitation (A.R.) or aortic insufficiency (A.I.). Again, the heart muscle must compensate, but in this situation the pumping chamber must enlarge, or dilate, to accommodate the increased volume of blood returning to the chamber. The efficiency of the heart drops, and the dilated heart begins, at some point, to fail. Once again, this leads to symptoms of congestive heart failure (CHF)
Aortic valve disease can develop at any time in the course of life. Congenital blockage (stenosis) of the aortic valve can occur in utero and present as a life threatening form of heart failure in the newborn. Degeneration and calcification of the aortic valve commonly presents in the 8th and 9th decade of life. Regardless of the age or cause, aortic valve disease is both serious and life limiting. In most situations, medical treatment can reduce symptoms for a while, but surgical relief of the valve disorder is the only possible long term solution.
With this background, it is important to review the surgical management of aortic valve disease, and how the techniques of surgery determine patient outcomes over time. In this Learning Center presentation, a full review of the history of aortic valve surgery is not possible. However, the fundamentals will be reviewed, and contrasted with special reference to the Ross or Pulmonary Autotransplant procedure. At this point, you can use the links below to jump off and explore several other topics related to the Ross procedure. It is recommended that you begin with reviewing the surgical anatomy and history of the development of the pulmonary autotransplant operation, and then the discussions of patient selection and sugical technique. Each page contains links to the other Ross topics.
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