Aortic valve replacement with a pulmonary autograft in infants with critical aortic stenosis.

Seven patients with critical aortic stenosis underwent aortic valve replacement with a pulmonary autograft (the Ross operation) between the ages of 5 weeks and 9 months. The operation was considered mandatory for survival because of continued severe heart failure or valve avulsion. Six of the patients had undergone unsuccessful previous palliations, such as commissurotomy, balloon dilation, and transventricular valvotomy, performed singly (n = 1) or in combination (n = 5). The other patient with a severely hypoplastic aortic valve ring underwent the Ross procedure as a primary operation. Two operative deaths occurred. In both cases severe endocardial fibroelastosis was detected at autopsy. One late death 1 year after the operation resulted from progressive hypertrophic cardiomyopathy and pulmonary hypertension. The rest of the patients are doing well, without medications. Apart from trivial regurgitation in two patients, the pulmonary autograft is performing well.