The Ross Procedure
(Flash animation, less than 70 KB)
How Is It Treated? -Part 1
When the obstruction is significant, surgical treatment may be necessary.
In cases where the aortic valve is undersized, thickened, or malformed (Valvular Aortic Stenosis), the initial treatment involves the widening of the opening to allow a greater flow of blood into the aorta. This may be achieved either by a surgical or a balloon valvuloplasty.
Surgical valvuloplasty involves reshaping the aortic valve during an operation. In a Balloon Valvuloplasty, which may be done in the cath lab, a catheter with a balloon at its end enters the heart, usually by way of an arm or leg vein and the inferior vena cava, and is inflated in the narrowed valve in order to widen the opening.
Eventually, most stenotic aortic valves will become insufficient (leak) and require a valve replacement operation later in life. This may be done by replacing the aortic valve with the patient's own pulmonary valve and then replacing the pulmonary valve with a human donated valve (the Ross repair shown in the animation). Another alternative usually reserved for older children and adults is replacement with a prosthetic (artificial) mechanical valve.
In cases where the narrowing in the aorta is above the aortic valve (supravalvular stenosis), the obstructing portion is removed and the remaining parts of the vessel are stitched together (see animation at right).