András Kollár

External subcommissural annuloplasty to prevent regurgitation in the pulmonary autograft

In pediatric patients, the further growth potential is a major advantage in using the pulmonary autograft (Ross procedure). The authors describe a modified annuloplasty technique that appears to prevent the development of undesirable aortic regurgitation associated with root enlargement while not affecting overall tissue growth in the autograft.

Aortic root abscess with aortico-mitral discontinuity after a ross operation in a child: reconstruction with an oversized homograft.

Abstract  A case of early neo‐aortic root abscess following a Ross operation in a 3½‐year‐old child is described. The infection destroyed neo‐aortic wall with two of the semilunar leaflets detached, and the abscess cavity extended across the intervalvular fibrous body into the left atrium and onto the native mitral valve creating partial “aortico‐mitral discontinuity.” Reconstruction was successful with an oversized cryopreserved homograft. (J Card Surg 2004;19:155‐157)

Redo procedures for correction of the aortic valve diseases in infants and children. The Bentall–Konno procedure

On an infant with critical valvular aortic stenosis balloon-valvoplasty, and 3 years later because of the aortic valve regurgitation Ross operation was performed. In the early postoperative period an aortic-root abscess occurred due to an infective endocarditis; the aortic root was corrected by homograft implantation. Due to a relatively small, calcified aortic valve, with aortic valve regurgitation grade III at the age of 12 years, a Bentall-Konno procedure was performed successfully. This is the first case when this complex surgical procedure was performed successfully on a child in Hungary.

The role of Ross procedure in the management of congenital heart defects

INTRODUCTION The surgical strategy to manage multilevel left ventricular outflow tract diseases is changing constantly, however, the Ross-procedure has remained a standard method for 45 years. AIM The aim of the study was to analyze early and mid-term results of Ross-procedure in congenital heart defects (single surgeons results). METHODS From 2001 until 2011 a total of 63 patients (age, 28 days-21 years; mean: 10 years, weight 3.4-96 kg; mean, 8.8 kg) underwent Ross (n = 40), Ross-Konno (n = 17) or Ross-Konno-mitral (n = 6) procedures. Indication for Ross procedure was aortic regurgitation in 15 patients (associated with ventricular septum defect in 8 patients) and a predominant aortic stenosis in 25 patients. 17 patients with severe left ventricular outflow tract obstruction underwent Ross-Konno procedure. 6 patients with concomitant mitral valve disease (Shone syndrome, 3 patients; complete atrioventricular septal defect, 3 patients) were reconstructed by Ross-Konno-mitral valve procedure. RESULTS Among Ross patients there were one early (cerebral complication) and one late death (homograft endocarditis) with a mean follow-up time of 7.4±1.8 years. Because of an early autograft endocarditis a 3-year-old boy underwent homograft implantation and was treated successfully with Bentall-procedure 9 years later. One patient with autograft regurgitation is waiting for reoperation. Among Ross-Konno patients there was no early or late death, and none of the patients underwent reoperation. In Ross-Konno-mitral patients there was one early death (28-day-old boy) and during a mean follow-up time of 2.5±1 years, and no reintervention or reoperation was needed in 5 patients. CONCLUSIONS The results indicate a good outcome of Ross-, Ross-Konno-, Ross-Konno-mitral procedures in patients with congenital heart defects when surgery is performed by a highly experienced heart surgeon. In newborns, infants and small children Ross- and Ross-Konno procedures are the only methods for managing left ventricular outflow tract diseases. Concomitant severe mitral disease adds a high level of technical complexity to the Ross-Konno/mitral procedure, but it should be balanced against alternative strategies (eg. single ventricle palliation or transplantation).

Csecsemő- és gyermekkori REDO műtéteket igénylő aortabillentyű-betegség. Az első magyarországi Bentall–Konno-műtét gyermekkorban@@@Redo procedures for correction of the aortic valve diseases in infants and children. The Bentall–Konno procedure

On an infant with critical valvular aortic stenosis balloon-valvoplasty, and 3 years later because of the aortic valve regurgitation Ross operation was performed. In the early postoperative period an aortic-root abscess occurred due to an infective endocarditis; the aortic root was corrected by homograft implantation. Due to a relatively small, calcified aortic valve, with aortic valve regurgitation grade III at the age of 12 years, a Bentall-Konno procedure was performed successfully. This is the first case when this complex surgical procedure was performed successfully on a child in Hungary.