# Pulmonary valve neo-reconstruction using the Ozaki technique in an adapted Ross procedure: case report

## TL;DR

This case report describes a modified Ross procedure using a new pulmonary valve technique to treat aortic valve disease without needing homografts.

## Contribution

The paper introduces a neo-reconstruction technique for the pulmonary valve in the Ross procedure using autologous pericardium, avoiding homograft dependency.

## Key findings

- The modified Ross procedure with Ozaki's neo-cuspidalization resulted in no aortic valve regurgitation and low pressure gradients.
- The new pulmonary valve showed minimal regurgitation and acceptable function four months post-surgery.
- The technique is viable for centers without access to pulmonary homografts.

## Abstract

Aortic valve damage is the most common valvular heart disease in developed countries. The Ross procedure is an alternative to the aortic valve replacement with a prosthesis, providing a longer survival without reoperation and without the need for anticoagulation therapy. The unavailability of homografts for the pulmonary valve replacement is one of the limiting factors for a more common utilization of this therapeutic method.

This case report presents a 35-year-old Caucasian male with a bicuspid aortic valve and severe aortic regurgitation. The patient underwent the Ross procedure with the stabilization of the aortic ring and sinotubular junction. A tubular prosthesis was created from the bovine pericardium, into which three neo-cusp valves were fashioned from autologous pericardium. The new pulmonary conduit was sutured distally to the distal pulmonary trunk and proximally to the right ventricular outflow tract. Four months post-operatively, the follow-up echocardiographic examination documented that the valve in the aortic position had no regurgitation, a maximum velocity of 1.25 m/s, and a peak gradient of 6.25 mmHg. The valve in the pulmonary position showed a trace regurgitation and mean pressure gradient of 13 mmHg.

The combination of the modified Ross procedure with neo-cuspidalization according to Ozaki for a new pulmonary valve thus offers hope for an extended survival without reoperation in paediatric and non-elderly adult patients with an aortic valve dysfunction. This technique is additionally applicable by cardiac surgery centres without access to pulmonary homografts.