| Ross Operation for a Case of
Secondary Aortic Regurgitation due to Infective Endocarditis |
(Department of Cardiothoracic Surgery, Kobe Children's
Hospital, Kobe, Japan)
| Takeyoshi Ota |
Masahiro Yamaguchi |
Masahiro Yoshida |
| Naoki Yoshimura |
Yoshio Ootaki |
Tomomi Hasegawa |
|
A 6-year-old boy was admitted with
infective endocarditis and aortic regurgitation. Clinical signs
of infection were severe. The leukocyte count was 13,100/µl and
the C-reactive protein (CRP) was elevated to 17.2mg/dl. Blood
culture was positive for Staphylococcus aureus. Echocardiography
showed a vegetation 3mm in diameter on the aortic valve, and
a perforation of the right coronary cusp with moderate aortic
regurgitation. With antibiotic therapy, clinical signs and laboratory
data of infection improved at an early stage. We decided to operate
after his complete recovery from infection. Laboratory data normalized
completely in 6weeks, but echocardiography
demonstrated aneurysmal change of the right coronary sinus and
severe aortic regurgitation. The Ross operation was performed
on the 44th day. At operation, it was noted that the non-coronary
cusp was destroyed completely leaving only strings of fibrous
tissue. A perforation of 3mm in diameter was also found on the
right coronary cusp. There was a mural aneurysm near the right
coronary orifice without abscess formation in the surrounding
structure. A pulmonary autograft was transplanted to the aortic
root after resection of the destroyed aortic cusps, aortic root
and the mural aneurysm. The right ventricular outflow tract was
reconstructed using an autologous pericardium as a posterior
wall and the Monocusp ventricular outflow patch (MVOP) #22 as
an anterior transannular patch. The postoperative course was
uneventful. Postoperative echocardiography revealed no aortic
regurgitation.
Jpn. J. Cardiovasc. Surg. 33: 291-294 (2004) |
|
