Intermediate-term results of Medtronic freestyle valve for right ventricular outflow tract reconstruction in the Ross procedure.

BACKGROUND AND AIM OF THE STUDY: The Ross procedure has become the first choice for aortic valve replacement in children and young adults at many institutions. Since 1997, a lack of availability of homograft valves in Turkey has prompted the use of alternative substitutes for right ventricular outflow tract (RVOT) reconstruction during the Ross procedure. METHODS: Before April 2005, among 20 patients (age range: 14 months to 45 years) at the present authors' institution, the Ross procedure was performed in 14 and a Ross-Konno procedure in six. Sixteen patients underwent RVOT repair using alternative methods for homograft valve replacement. Fourteen patients received a Medtronic Freestyle valve and one patient a Medtronic Contegra bovine jugular vein conduit. An autologous RVOT repair was used in one patient. Ten of the Medtronic Freestyle valve patients were aged <16 years. In all patients who received a Medtronic Freestyle valve echocardiographic evaluations were conducted shortly after surgery and during follow up. RESULTS: There was no early mortality. One patient died from pneumonia after six months, and another (asymptomatic) patient died suddenly at 34 months after surgery. Before hospital discharge the mean peak pressure gradient across the Freestyle valve was 12.1 +/- 11.0 mmHg, and this increased to 24.1 +/- 20.0 mmHg after a mean follow up of 51.2 +/- 6.9 months (range: 6 to 101 months) (p <0.002). Mild pulmonary regurgitation was seen in two patients. One asymptomatic adult patient was reoperated on at another center because of a 60-mmHg echocardiographic peak gradient at four years postoperatively. CONCLUSION: Although long-term follow up is required to explain the durability of the Medtronic Freestyle valve, the present results show that the valve can be used with intermediate-term success in the Ross procedure - and even in children as an alternative - if homograft valves are not available.

Ross-Konno procedure and ostial plasty in a child with homozygous hypercholesterolemia: case report.

Although the Ross procedure is preferred for aortic valve replacement in young and female patients, there are no reported cases of hypercholesterolemic aortic pathology due to homozygous familial hypercholesterolemia. Long-term durability of the pulmonary autograft in patients with postoperative high blood cholesterol levels is of interest. A 14-year-old girl with homozygous familial hypercholesterolemia who underwent the Ross-Konno procedure and left coronary artery ostial plasty was followed for 57 months, with pulmonary autograft function, coronary arteries and lipid profile being monitored. There were no signs of narrowing, insufficiency or calcification of the pulmonary autograft; neither was there any narrowing in the left main coronary ostium. The patient's total cholesterol level was reduced from 897 to 262 mg/dl by use of anti-lipidemic medication and weekly lipid apheresis. Follow up data suggest that a pulmonary autograft may be preferable in children with hypercholesterolemic aortic valvular pathology, as well as in children with aortic valvular diseases of other etiologies.

How does neonatal thymectomy affect the immune system?

BACKGROUND: The aim of this study was to determine the effects of neonatal thymectomy on the immune system in later life. METHODS AND RESULTS: Immune system tests were performed in 26 children at 1 year of age. Thirteen of them had been operated for transposition of the great arteries and had thymectomy in the same operation in the neonatal period. Thirteen control subjects were normal. Immune system tests including white blood cell count, lymphocyte count, T and B cells subgroups (CD2, CD4, CD5, CD7, CD8, CD16, CD20, CD22, CD56), mitotic reaction to phytohaemagglutinin in lymphocyte culture. White blood cell count and lymphocyte count were performed. In the statistical analysis, Mann-Whitney U and Wilcoxon rank sum W tests were used for both groups. Statistical significance was taken at a value of P < 0.05. There was no significant difference in mean white blood cell count, mean blastic transformation reaction of lymphocytes to phytohaemagglutinin, and CD7, CD4/CD8, CD20, CD22, CD56 ratios between the two groups (P > 0.05). Significant differences in mean lymphocyte number, and CD2, CD4, CD5, CD8, CD16 ratios between the two groups were defined (P < 0.05). CONCLUSIONS: In our study, it was noticed that mainly T lymphocyte subgroups were effected by neonatal thymectomy. Although no infection requiring therapy was seen in the thymectomized patients, we advise to limit total thymectomy as much as possible in neonatal heart operations.

Aortic dissection due to sildenafil abuse.

This report deals with a 28-year-old male patient, admitted with a type A aortic dissection, potentially related to the use of sildenafil. In the literature, we found only two other potentially sildenafil-related cases of aortic dissections, one type A and one type B. In our patient, a bicuspid aortic valve and an ascending aortic aneurysm were other underlying anomalies that could have led to the aortic dissection.