Six month evaluation post Ross Procedure

[PapaHappyStar]

I had my six-month post Ross Procedure ( AVR with own pulmonary valve + pulmonary replaced with a prosthetic valve -- in my case a pulmonary homograft ) evaluation. The new aortic valve looks good on the echo -- no regurgitation or significant gradient. The pulmonary homograft has a small gradient across it ( max pressure difference 18mmHg ) and mild-moderate regurgitation.

The cardiologists opinion is: this is not unusual behavior post RP and she is not too concerned about it. This does not indicate wear or rejection -- perhaps there has been some remodeling of the pulmonary root resulting in the regurgitation. She also does not think there will be any physiological effects of this and expects the condition of the valve will remain stable. My next evaluation will be in a year.

I dont have a typed-up report as yet, but this sounds fairly good to me -- I think she is right about pulmonary regurgitation being well tolerated in adults. If the result of my Ross Procedure is: I dodge the aortic valve disease in exchange for ( slowly ) progressing pulmonary valve regurgitation then I will be quite happy with it -- hopefully the pulmonary valve can be replaced via a less invasive/dangerous techique ( catheter/robot w/o cardio-pulmonary bypass ) if it needs to be ( eventually ).

Any experiences with progressive pulmonary valve regurgitation?

 

[hensylee]

Is it already six months? Hard to believe how time quickly passes. You sound really good. Aren't we always glad to get past a milestone.

 

[Wise]

Burair: Glad for your good report. Too bad it couldn't have been a perfect outcome, but as you say, if you eventually have to deal with your pulmonary valve that it may be a breeze due to evolving surgical technology. Anyway, glad you're doing so well.

 

[Sherry]

Hello, Burair. Glad to hear you had a positive post-op evaluation. I know from past experience and about eight post-op echos that I've gotten various reports regarding regurgitation and chamber sizes. It seems the subjective nature of this test reveals some discrepancies in the readings. I know mine have certainly shown that. Take care and give my best to Ammina and Ishaq.

 

[surfsparky]

Hi Burair,
Good to hear about your positive evaluation. Post-op echoes and evaluations are always a bit of an anxious time, because you never quite know what is going to show up. My husband Chris, is a fellow "rosser" and it's been two years since his surgery. His pulmonary homograft unfortunately has quite a high pressure gradient (42mmHg) at present but it has not increased over the past 6 months. Prior to this the gradients were increasing every six months. From the research we have done, the majority of pulmonary homografts show some increased pressure gradients within the first year of surgery. It is only in some rare cases that the pressure gradients continue to rise. Anyway, sounds to me (in my non-expert opinion!) that what is happening to you is pretty standard for Ross patients.
All the best,
Yolanda (Chris' wife)

 

[geebee]

Burair,

Hard to believe it's been so long. Happy to hear about the aortic and I will pray for the best about the pulmonary. Hopefully it will settle in and all will be perfect.

Take care.

 

[PapaHappyStar]

Thanks for the replies everyone -- I too am quite optimistic about the prognosis from this evaluation. I havent been told to limit my activities and am in general satisfied with the progress in physical conditioning.

She did mention the variability in the measurement via echo of the regurgitation -- probably a combination of real temporary fluctuations in the valve and measurement accuracy. The valve was leaking "trivially" in the first post-op echo and there was a small gradient then as well.

Its true: The passage of time has been accelerating for me since the surgery -- the first month felt like a few years the second was much quicker and I've been ripping page after page from my calendar at increasing pace since.

My physical goals for the end of summer:
Bike 20K + Swim 1K sequentially in less than 50 mins cumulative.

So plenty of work left to do....

Burair.

 

[gijanet]

Sounds like good news to me, too.

Sounds like good news to me, too.

I dont have a typed-up report as yet, but this sounds fairly good to me -- I think she is right about pulmonary regurgitation being well tolerated in adults. Any experiences with progressive pulmonary valve regurgitation?

Sorry I can't help about the pulmonary valve regurge. Katie has quite the opposite - pulmonary stenosis. Overall, I think you got a great checkup, though. I can't believe it has been six months either...............sigh! Hugs and congrats. J.

 

[PapaHappyStar]

Hi Burair,
Good to hear about your positive evaluation. Post-op echoes and evaluations are always a bit of an anxious time, because you never quite know what is going to show up. My husband Chris, is a fellow "rosser" and it's been two years since his surgery. His pulmonary homograft unfortunately has quite a high pressure gradient (42mmHg) at present but it has not increased over the past 6 months. Prior to this the gradients were increasing every six months. From the research we have done, the majority of pulmonary homografts show some increased pressure gradients within the first year of surgery. It is only in some rare cases that the pressure gradients continue to rise. Anyway, sounds to me (in my non-expert opinion!) that what is happening to you is pretty standard for Ross patients.
All the best,
Yolanda (Chris' wife)

Yolanda,
Hope Chris' measurements stay stable -- have they discussed the posibility of "ablating" the valve and/or using a balloon on a catheter to stretch it?
Best,
Burair

 

[tobagotwo]

I'm happy that you have received a good report, Burair. The pulmonary regurgitation may well not affect you for a very long time, and perhaps never. We all live with small compromises.

Be well,

 

[surfsparky]

Yolanda,
Hope Chris' measurements stay stable -- have they discussed the posibility of "ablating" the valve and/or using a balloon on a catheter to stretch it?
Best,
Burair

Hi Burair,
We raised that possibilty with the surgeon and I can't remember the exact reason why, but Chris and I both came away thinking that it would not even be a remote possibility. I have a feeling (which could be wrong) that it had something to do with it being a delicate procedure when used on grafted valves. Perhaps there is a risk of stretching the sutures/ places of attachment? The surgeon said too, that doing the procedure (when successful) does not improve the valve function significantly to warrant it.
I forgot to mention in my other post that Chris had quarterly echoes in the first year post op due to the increase in pressure gradients on the pulmonary homograft. So I would predict that your pressure gradients would not increase given that you do not need a follow-up for a year.
Unfortunately Chris is one of those "rare" ones...he is so worth it though!
Cheers,
Yolanda