The Ross procedure in the acute phase of infectious endocarditis in childhood

The Ross procedure of aortic valve replacement with a pulmonary autograft h as several advantages in childhood over mechanical prostheses or homografts , especially in infectious endocarditis requiring early surgery. Between January 1997 and July 1998, 3 children with no known previous cardi ac disease, aged 14 months, 10 and 11 years, had aortic valve infectious en docarditis. The causal organism was not identified in 1 case and the other two were due to staphylococcus aureus and corynebacterium diphteriae. All c hildren had severe, rapidly progressive aortic regurgitation complicated by pulmonary oedema in the baby and systemic emboli in the two older children . Surgery was performed within 9 days, 1.5 month and 2 months after the ons et of the disease. The postoperative course was uncomplicated in the 3 case s. Postoperative Doppler echocardiography showed absence of autograft dysfu nction or stenosis, with the presence of pulmonary regurgitation in 1 case. Pulmonary autograft has the advantages of not requiring anticoagulation, of allowing growth of the aortic ring, of not being limited by the age of the patient and of having a low risk of degeneration and infectious endocardit is. Therefore, it seems particularly indicated for cases of complicated inf ectious endocarditis requiring early aortic valve replacement. The early (4 .8%) and late (4.3%) mortality rates were comparable to those of other tech niques and are lower than those associated with valve replacement with mech anical prostheses in cases of endocarditis (8.5% versus 40%). The secondary morbidity is 18.8% with dysfunction of the autograft and/or stenosis of th e pulmonary homograft. Despite is limited follow-up, aortic valve replacement by a pulmonary homog raft seems better than aortic valve replacement with a homograft or mechani cal prosthesis,especially in cases of complicated infectious endocarditis r equiring surgery in the acute phase. Further studies are required to confir m these encouraging results.