Ross Procedure for Damaged Aortic Valve in Children and Teens

Ross Procedure for Damaged Aortic Valve in Children and Teens

Jonathan Chen, MD: The Ross procedure is a surgical technique that can be used to replace a damaged or diseased aortic valve. I'm Jonathan Chen, a surgeon in the Pediatric Heart Valve Center at Children's Hospital of Philadelphia.

My team is one of the most experienced in the country in valve repair and replacement, and we regularly perform the Ross procedure. To better understand the procedure, let's first take a look at the anatomy of your heart. This is your heart. It has four chambers and four valves. Blood passes through a valve before leaving each chamber of the heart. The valves prevent the backward flow of blood.

To understand the Ross procedure, you'll need to know about the aortic valve and the pulmonary valve. The heart's lower chambers are called ventricles. The left ventricle pumps oxygen-rich blood through the aortic valve and into the aorta, the largest artery in the body. Blood travels from the aorta to blood vessels throughout the body, delivering oxygen and nutrients. Blood that has traveled through your body and is now low in oxygen goes into the right side of the heart.

The right ventricle pumps the blood through the pulmonary valve, into the pulmonary artery and to the lungs for more oxygen.

If the aortic valve is diseased or damaged, it can be surgically removed and replaced with the body's own healthy pulmonary valve. This is known as the Ross procedure. Here's how it works. First, the surgeon must detach the coronary arteries from the aorta. The coronary arteries are the blood vessels that feed oxygenated blood to the heart.

Then the surgeon will remove the diseased or damaged aortic valve, as well as the aorta surrounding the valve. The healthy pulmonary valve, surrounded by a cylinder of pulmonary artery, is then removed from its usual location and sewn into the aortic position. This is called an autograft. The surgeon then reattaches the coronary arteries to the autograft.

A donor cadaver pulmonary valve surrounded by a cylinder of pulmonary artery is then attached replacing the original pulmonary valve. This is called a homograft.

The Ross procedure is a highly technical surgery. At the Valve Center at Children's Hospital of Philadelphia, our team uses cutting edge imaging to view each patient's heart before surgery. This allows us to develop a highly personalized surgical plan based on your child's unique anatomy. As with any heart surgery, the Ross procedure has advantages and disadvantages.

Because the Ross procedure uses the patient's own tissue, there's little risk of clotting. This means your child won't need to take long-term blood thinners. The pulmonary valve in the aortic position, remember this is called the autograft, continues to grow with your child, so it won't need to be upsized as your child grows. Sometimes, however, the autograft has to be replaced because of wear. The donor pulmonary valve, remember this is called the homograft, does not grow.

In kids, it will eventually need to be upsized, which will require a future operation. In teenagers and adults, the homograft won't need to be upsized, but the valve inside the homograft might become leaky. If that happens, the valve can probably be replaced through a catheterization instead of surgery. Our team is a world leader in the Ross procedure.

We work together and with you, to make the best decisions for your child before, during, and after surgery.