Ross Procedure Complication?

[Luke]

Hello Everyone,

I had the Ross procedure done this past June. I've had a number of different problems after that. A few include two procedures(one for gall bladder removal the other was an ablation for AVNRT.)

Now my oxygen levels drop to 85% when sleeping. I had a number of sleep studies done, and I do not have apnea. Echo last week showed that my right ventricle is enlarged and my pulmonary arteries show an increase in pressure. My cardiologist is out of town and I am supposed to review the results with him next week. A friend of mine is a cardiologist and said what I described sounds like what some people go through with the Ross. He said they construct a conduit during the Ross connecting the right ventricle to the pulmonary arteries. Sometimes scar tissue forms and interferes with blood flow causing the right ventricle to enlarge. Has anyone here heard of this or had it? What have they done to help it. Any input would be helpful. Thanks!

 

[ALCapshaw2]

Hello Everyone,

I had the Ross procedure done this past June. I've had a number of different problems after that. A few include two procedures(one for gall bladder removal the other was an ablation for AVNRT.)

Now my oxygen levels drop to 85% when sleeping. I had a number of sleep studies done, and I do not have apnea. Echo last week showed that my right ventricle is enlarged and my pulmonary arteries show an increase in pressure. My cardiologist is out of town and I am supposed to review the results with him next week. A friend of mine is a cardiologist and said what I described sounds like what some people go through with the Ross. He said they construct a conduit during the Ross connecting the right ventricle to the pulmonary arteries. Sometimes scar tissue forms and interferes with blood flow causing the right ventricle to enlarge. Has anyone here heard of this or had it? What have they done to help it. Any input would be helpful. Thanks!

This sounds like something that you should discuss with your Surgeon as well.

After you have talked with your Cardio and Surgeon, you may also want to contact Dr. Paul Stelzer in NY for his perspective as (probably) the most prolific Ross Procedure Surgeon in the country (or world?).

'AL Capshaw'

 

[DeuxofUs]

I agree with Al, I would contact Dr Stelzer. Nicest man !!! I have spoken with him on a few occasions and plan to have my surgery with him. He is considered one of the top if not THE top RP surgeon.

 

[Lynlw]

It sounds like your friend is talking about pulmonary stenosis, Which can happen with any of the pulmonary valve/conduit (right ventricle outflow tract) surgeries. I know that could cause pressure in the right ventricle to increase since the blockage keeps blood from leaving it and getting to the lungs, so it backs up in the right ventricle.. Altho I'm not sure why that would cause your O2 to drop at night, normally if the O2 levels are lower because of problems with the pulmonary valve or conduit they would be consistantly low through out the day/night. How do you feel? Were you having symptons or is this something they found, during routine testing?

Do you know what kind of valve/conduit you got for the pulmonary side? IF it is a problem with pulmonary stenosis, what treatment they can do would depend where and what is causing the stenosis. It could be on the valve itself in the conduit or on the seams they sew. Were they able to see any stenosis during the echo or just going by the increased right ventricle pressure? Its hard to guess until you talk to your cardiologist or have all the results and numbers from the echo.( right ventricle size, gradients, pressure etc) Sometimes they can't get good looks at the conduit during an echo, so may need to have an MRI done to get better answers, IF it is a problem with the pulmonary valve/conduit and not something else causing the symptons.

IF it IS pulmonary valve or conduit stenosis and you decide to get 2nd opinions elsewhere, the centers/doctors that have the most experience with right side/ pulmonary valve issues are usually Congenital Heart Defect (CHD) Centers, since the vast majority of people who have pulmonary valve replacements are kids/adults born with some of the complex CHD and it usually isn't a valve that has aquired problems that happen in adults. Also pulmonary valve replacements are pretty rare compared to Aortic valves, I think out of 100,000 valve replacements each year only about 5,000 are pulmonary

IF there is a problem with the pulmonary valve /conduit, depending where and what it is would determine your options, anything from balloons or stents to open it, or needing to replace it, either by surgery or cath, again the CHD/Adult CHD centers would probably have the doctors/surgeons who are the most up to date on the various options.

Good Luck, I hope you are able to get answers next week.

 

[Bryan B]

As someone who had a Ross Procedure it was explained to me that pulmonary stenosis was a possible complication of the homograft pulmonary valve. They also explained that this condition did not always require surgery, it was basically a symptom specific call as to whether or not to replace it. This is something you need to talk with your cardiologist and possibly your surgeon about. They probably need to do some further testing to get a better picture of whether or not there is a problem, and if so how severe. I know you have had the echo and you have a lot of things going through your mind. And I know it's hard not to think of the worst scenarios. Getting some answers will help regardless if it is good news or bad news. Even if your homograft does need to be replaced it is the easiest of all valves to replace because it is outside of the heart and easily accesible. As a matter of fact catheter based replacement of the pulmonary valve is becoming more common since it doesn't require cutting into the heart.

BTW I had to have a redo to replace my autograft and aortic root due to aortic root and ascending aorta dilation. He said my homograft looked so good he didn't even consider replacing it. He said in his estimate it is probably good for another 20 years and it might go the "distance". He said many people do fine with pulmonary stenosis and whether or not to replace it was largely based on symptoms. I will need at least one more re-op since I got a tissue valve so I am sure they will revisit the homograft at that time.

But the bottom line is to not assume the worst until you talk with the experts that know your history.