The pulmonary valve is rarely affected by chronic rheumatic valvulitis. Therefore it is the most suitable living
substitute for the diseased Aortic and Mitral valves (Ross Procedures).In patients with pulmonary hypertension the pulmonary
valve withstands systemic pressure, the pulmonary arterial wall thickens and the hypertrophied Right ventricular muscle protects
the first septal artery during explantation. These changes make the pulmonary autograft even more suitable for replacing diseased
Aortic and Mitral valves. Unfortunately when transplanted to the aortic position in young rheumatics the autograft develops
rheumatic valvulitis in a short period of time.
From October 1993 to September 2003, 81 patients underwent the Ross procedure. Mean age was 29.5 Yrs(11-56). 40
patients were below 30 yrs of age. Mitral valve repair in 19, open mitral commissurotomy in 15, Tricuspid valve repair in 2 and
Mitral valve replacement with a homograft in 2, were the associated procedures.
The early mortality was 7.4%. At a median followup of 109 months (82% followup) 7 patients required reoperation for
autograft dysfunction. All were young (under 30) rheumatics and had mitral valve disease. Explanted autograft cusps showed
typical changes of rheumatic valvulitis.
The pulmonary autograft is not a suitable substitute for diseased aortic valve in young rheumatics.
Arkalgud Sampath Kumar has retired from All India Institute of Medical Sciences in 2009 as Head of cardiothoracic surgery and has 40 yrs experience
in surgery for RHD. He is a member of many international professional associations and he is currently in private practice. He is the Editor in Chief
of Asian Cardiovascular and Thoracic annals. He has more than 200 publications including 3 textbooks. This abstract is from a previously publishe
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