Semilunar valve switch in aortic insufficiency

The use of the Ross procedure in young patients is gaining wideracceptance. The need for a foreign pulmonary valve that will requirereplacement, however, is a serious drawback. To circumvent this problem, wereimplanted the native aortic valve in the pulmonary position in fourpatients (ages 12, 15, 15 and 17 years old) operated on utilizing the Rossprocedure for aortic insufficiency. One patient had congenital and threeisolated rheumatic aortic insufficiency. The root replacement techniquewith coronary artery reimplantation was used. All patients did wellinitially with marked reduction of left ventricular dilatation and goodfunction of the reimplanted native aortic valve. One patient, however, dieda month later from rupture of a false aneurysm that developed at thepulmonary autograft to ascending aorta anastomosis. We feel that the use ofthe native aortic valve in the pulmonary position makes the Ross proceduremore attractive and potentially curative. The diseased aortic valve workswell in the pulmonary position because of lower pulmonary artery pressureand resistance.