External subcommissural annuloplasty to prevent regurgitation in the pulmonary autograft

摘要

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 regurgitation (AR), due to size mismatch or root dilatation later on, is a feared complication of the Ross procedure. Reduction annuloplasty and/or aortoplasty methods have been used for size mismatch, and most recently, the inclusion root technique has been advocated by some to prevent graft dilatation in adults [1]. In children, however, preserving the autograft's growth potential is of primary importance, and in most cases, the above techniques are not applicable. In our newly started pediatric Ross program, we have developed a modified annuloplasty method to prevent regurgitation on the neoaortic valve.