Back to 2024 Abstracts
Ross Procedure Following A Norwood For Biventricular Conversion
Maroun Yammine, MD, Edward Buratto, MD, PhD, Emile Bacha, MD.
Morgan Stanley Children’s Hospital, New York Presbyterian, Columbia University, New York, NY, USA.
Objective(s) and Methods:The patient was 5-months old, with history of neonatal critical aortic stenosis, Large VSD, Left ventricular outflow tract(LVOT) narrowing and aortic coarctation. They were referred for second stage palliation following a Norwood procedure at age 2weeks. Preoperative workup showed normal biventricular function and size and appropriately functioning valves; favorable for biventricular conversion. There was size mismatch between the DKS and aortic arch with 30mmHg gradient on catheterization and significant LVOT narrowing.
Results:Following transection of the DKS, the distal arch was patch augmented under circulatory arrest at 18degress. The coronary buttons were developed and aortic valve resected.The autograft was harvested without cutting into the VSD but preserving the base of the conus septum which was severely posteriorly deviated.The underdeveloped native LVOT was enlarged by thinning the outlet septum along the direction of the Right-Left commissure until it matched the autograft size. The VSD was patch closed via the RVOT before implanting the autograft into the neoaortic annulus.The left coronary button was sutured on the autograft, it aligned best at the anatomic non-coronary sinus. The pulmonary homograft distal anastomosis was performed followed by the distal autograft anastomosis. The caudal half of RCA button was anastomosed on the autograft and the cranial half on the ascending aorta before completing the proximal homograft anastomosis and ASD closure.
Conclusions:Postoperative TEE and pre-discharge TTE showed patent LVOT with competent neoaortic valve, good biventricular function and no residual lesions. The chest was later closed and the patient discharged home after 10 days of hospitalization.
Back to 2024 Abstracts
