Our Summary

This paper discusses a case where a patient had a problem with the function of a transplanted lung part (pulmonary homograft dysfunction). This issue occurred after a specific heart surgery known as the Ross procedure and is difficult to treat. It can cause serious illness or even death if another operation is needed. The patient developed a severe narrowing of the transplanted lung part only 18 months after the surgery. However, the doctors successfully treated the patient using a non-surgical method called transcatheter pulmonary valve replacement.

FAQs

  1. What is pulmonary homograft dysfunction and how does it impact patients with a previous Ross procedure?
  2. What is the Ross procedure and what are its potential complications?
  3. How is severe pulmonary homograft stenosis managed and what role does transcatheter pulmonary valve replacement play in this?

Doctor’s Tip

One helpful tip a doctor might tell a patient about pulmonary valve replacement is to closely follow post-operative instructions for monitoring and caring for the new valve. This may include regular follow-up appointments, taking prescribed medications as directed, and maintaining a healthy lifestyle to support overall heart health. It is also important to report any symptoms of concern, such as chest pain, shortness of breath, or palpitations, to your healthcare provider promptly. By staying vigilant and proactive in your care, you can help ensure the long-term success of your pulmonary valve replacement.

Suitable For

Patients who may be recommended for pulmonary valve replacement include those with congenital heart defects such as Tetralogy of Fallot or pulmonary atresia, as well as patients who have previously undergone a Ross procedure and are experiencing pulmonary homograft dysfunction. These patients may present with symptoms such as shortness of breath, fatigue, chest pain, or palpitations. In cases of severe pulmonary homograft stenosis or regurgitation, pulmonary valve replacement may be necessary to improve symptoms and prevent further complications. Transcatheter pulmonary valve replacement may be a suitable option for select patients, offering a less invasive alternative to traditional surgical valve replacement.

Timeline

Before pulmonary valve replacement:

  • Patient undergoes a Ross procedure, during which their diseased pulmonary valve is replaced with a pulmonary homograft.
  • Patient experiences symptoms of pulmonary homograft dysfunction, such as shortness of breath, chest pain, and fatigue.
  • Patient undergoes diagnostic tests, such as echocardiograms and cardiac catheterization, to assess the severity of the homograft dysfunction.
  • It is determined that the patient requires pulmonary valve replacement due to severe homograft stenosis.

After pulmonary valve replacement:

  • Patient undergoes transcatheter pulmonary valve replacement, a minimally invasive procedure to replace the dysfunctional pulmonary homograft with a new bioprosthetic valve.
  • Patient experiences a successful outcome, with improvement in symptoms and hemodynamic parameters.
  • Patient undergoes regular follow-up visits to monitor the function of the new pulmonary valve and to assess for any potential complications.
  • Patient is able to resume normal activities and enjoy an improved quality of life following the pulmonary valve replacement.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with pulmonary valve replacement surgery?
  2. How long is the recovery time after the procedure, and what is the expected outcome?
  3. Will I need to take any medications after the surgery, and if so, for how long?
  4. How often will I need follow-up appointments and monitoring after the procedure?
  5. Are there any lifestyle changes or restrictions I need to be aware of post-surgery?
  6. What are the long-term implications of having a pulmonary valve replacement?
  7. Are there any alternative treatment options available for pulmonary homograft dysfunction?
  8. How likely is it that I will need a repeat valve replacement in the future?
  9. Will I need any additional tests or evaluations before the surgery?
  10. What is the success rate of transcatheter pulmonary valve replacement in patients with a previous Ross procedure?

Reference

Authors: Morgant MC, Bernard C, Lorgis L, Bouchot O. Journal: J Cardiovasc Surg (Torino). 2024 Feb;65(1):76-78. doi: 10.23736/S0021-9509.24.12725-5. Epub 2024 Feb 12. PMID: 38345548