Tehran University Medical Journal

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Background: The Ross procedure has been known as a good method for aortic valve replacement. Pulmonary allograft postoperative stenosis subsequent to the Ross procedure has been noted as an important disadvantage of this technique, although risk factors related to this complication are not clearly recognized. In this study we evaluate the risk factors of pulmonary allograft stenosis after Ross procedure.
Methods: This retrospective cohort study was carried out on 42 patients who underwent the Ross procedure. Left ventricular outflow tract obstruction was repaired using pulmonary allografts 22.7±2.5 mm in diameter. Echocardiographic and clinical examinations were performed for all patients at six and 12 months after surgery. Echocardiographic data as well as data related to the allografts were recorded.
Results: The mean age of the patients was 28.5±10 years. Postoperative pulmonary valve stenosis was detected in 13 patients (31%). Nine patients (21.4%) had mild stenosis and four patients (9.5%) had moderate stenosis. No relationship was detected between the degree of stenosis and the size of allograft (p=0.08). There was a significant correlation between postoperative pulmonary stenosis and donor age (p=0.04). Predictive variables of pulmonary allograft stenosis after the Ross procedure were low donor and recipient age (p=0.03 and 0.05, respectively).
Conclusions: This study shows that the Ross procedure has a rather low incidence of postoperative stenosis and is a suitable substitute for aortic valve replacement. Low donor age is associated with pulmonary allograft stenosis formation, perhaps due to greater viability of tissue cells from younger donors.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Isolated pulmonary valve stenosis represents 8-10% of congenital cardiac anomalies. This study was performed to evaluate the late outcomes of Balloon Pulmonary Valvuloplasty (BPV) in children with residual infundibular stenosis.
Methods : Seventy-eight patients underwent BPV in Rajaee Heart Center in Tehran Iran, from 2008-2010. The patients were divided into two groups: with and without infundibular stenosis. The group with infundibular stenosis was subdivided into two groups: with and without propranolol administration. Gradient measurement follow-ups by Doppler echocardiography were done on the first day and 1, 3, 6 and 12 months afterwards.
Results: Thirty five (44.9%) patients were male and 43 (55.1%) were female. The mean age of participants was 4.29±3.5 years and the mean weight 16.18±8.8 kg 33 patients (43%) did not show residual infundibular stenosis but 45 (57%) did so in the evaluations. There were no significant differences between the two groups regarding age, weight, sex, kind of balloon valvuplasty, balloon to body surface area ratio and pulmonary regurgitation (PR). Propranolol was administered to 27 (60%) patients with residual stenosis for six months but 18 (40%) did not receive the medication. In both groups, the gradient significantly decreased immediately after BPV (P<0.0001). In the propranolol group a constant decrease in residual gradient was seen. There was a significant relationship between balloon to body surface area ratio (387±94mm²/m²) with moderate to severe PR (P<0.015).
Conclusion: BPV is a safe and effective procedure to treat PS. Residual infundibular gradient after BPV decreases over time and propranolol helps decrease the gradient.