罗斯过程

The Ross procedure is a surgical treatment for a diseased aortic valve. 心脏的四个瓣膜之一, the aortic valve controls the flow of oxygen-rich blood out to the body. 如果瓣膜变窄, 这种情况被称为主动脉狭窄, 心脏必须更加努力地工作来泵血, causing the muscle to thicken and potentially leading to heart failure. 如果主动脉瓣渗漏, 这种情况被称为瓣膜反流, 血液会回流到心脏, 最终也会导致心力衰竭.

The standard treatment for either condition is to replace the faulty valve with a prosthetic one that is either mechanical (made from a durable material, 如钛)或由动物组织制成. 但两者都不是完美的解决方案. 组织瓣膜磨损，必须更换, 而机械瓣膜容易形成血栓, which means patients with them have to take blood-thinning medications for the rest of their lives.

罗斯程序提供了另一种选择. The surgeon replaces the diseased valve with another of the patient's own heart valves, 肺动脉瓣. The swap works because 肺动脉瓣 is similarly shaped and can become thick and strong enough to function like an aortic valve. The pulmonary valve, in turn, is replaced with a valve from a cadaver donor.

For certain patients, the Ross procedure offers many advantages over standard valve replacements. 虽然这是一个更复杂的手术, 这种手术感染的风险较低, bleeding, 凝血和中风. There's no risk of the valve not fitting the patient's anatomy – a common problem with prosthetic valves. Also, the valves are more durable than animal tissue prosthetics and don't require the patient to take blood-thinning drugs.

这些优势对年轻患者最有意义. Elderly patients (those over 70) generally fare well with prosthetic valve replacements; the treatment nearly restores their normal life expectancy. In patients 60 and under, however, life expectancy is reduced with the standard valve replacements. The Ross procedure is the only type of aortic valve replacement to restore normal life expectancy in younger patients.

继续阅读

谁会受益

The Ross procedure is for younger patients with aortic valve disease but no other major medical problems, 比如肝脏, 肾脏或肺部疾病. We generally perform the procedure only in those around age 60 and under.

其他可能从手术中受益的人包括:

计划要孩子的妇女
Patients who are experiencing a failed valve from a previous aortic valve replacement
Those with a very small aortic valve in need of replacement (often women and children)

The treatment isn't an option for patients over 70 or people with Marfan syndrome; pulmonary valve disease; autoimmune disorders, such as lupus; or significant kidney, liver, lung, 冠状动脉或二尖瓣疾病.

Advantages

The Ross procedure's advantages over standard valve replacements include:

瓣膜的寿命比动物组织瓣膜长.
和组织瓣膜相比, the relocated valve has a lower risk of postoperative deterioration from calcification (tissue hardening caused by calcium deposits).
不需要服用血液稀释剂(不像机械阀).
降低瓣膜感染、出血或中风的风险.
减少身体排斥瓣膜的机会.
更容易调节血液流动.
使60岁以下病人的预期寿命恢复正常.

Evaluation

来决定你是否适合做罗斯手术, your doctor will assess the condition of your aortic valve and your overall cardiovascular health, 通常借助于以下一种或多种测试:

Echocardiogram. 也叫心脏超声, this noninvasive test uses sound waves to produce detailed images of your heart, allowing doctors to assess the structure of its chambers and valves and observe blood flow. 经胸超声心动图, the images are captured by placing a transducer (the device emitting sound waves) in various spots on the chest and abdomen. 经食管超声心动图, 一根细管将换能器送入食道, 使十大赌博平台排行榜能够获得人体内部的图像.
冠状动脉CT血管造影. This noninvasive test uses X-rays to create images of the blood vessels in the chest, 包括主动脉和肺动脉.
冠状动脉造影. 导管(细的), flexible tube) is threaded through a blood vessel in your wrist or groin to an artery in your heart, and a harmless dye that shows up well on X-rays is injected into the catheter. The test provides detailed images that reveal how well the coronary arteries are functioning and also allows doctors to measure the pressure inside the heart chambers.

Procedure

The Ross procedure is open-heart surgery, requiring general anesthesia (you're completely asleep). 外科十大赌博平台排行榜切开胸骨进入你的心脏. 因为你的心脏必须暂时停止跳动, 你被安置在心肺搭桥机上, 是什么让血液在你体内循环. 外科十大赌博平台排行榜检查并切除病变的主动脉瓣, then examines 肺动脉瓣 to check that it's a healthy and suitable replacement. If it is, the valve is removed and implanted in place of the aortic valve. 然后外科十大赌博平台排行榜植入一个供体肺动脉瓣. 手术通常需要4到5个小时.

Recovery

预计在十大赌博平台排行榜待5到7天, 前两三个在重症监护室. We encourage you to be up and walking within 24 hours of the surgery; most patients are able to do so. 在你术后住院期间, follow-up tests are performed to determine that your heart valves are functioning properly. These may include chest X-rays, blood tests, an electrocardiogram (EKG) and an echocardiogram.

回家之前, your heart care team will talk with you about how to care for yourself, 提供饮食指导, exercise, 小心你的切口, 以及使用现有或新的药物.

We recommend six weeks of restricted activity while you recover from the surgery. For part of that time, we may also prescribe certain medications, including:

利尿剂(增加排尿的药物)，所以你不会保留水分
止痛药，剂量逐渐减少
Beta-blockers to help keep your blood pressure low while your pulmonary valve "learns" how to be an aortic valve
ACE(血管紧张素转换酶)抑制剂, for additional blood pressure control or if you had severe valve regurgitation with a dilated left ventricle

Risks

虽然罗斯手术的结果经得起时间的考验, there is about a 1% per year chance of needing another procedure to fix issues with the aortic or pulmonary valve. (That's better than treatment with tissue valves but more frequent than with mechanical valves.大约有一半的时间, 我们不用开胸手术就能解决这个问题, 有一半的时间, 病人需要再做一次心脏直视手术. However, of the four main complications that can occur after aortic valve surgery – namely, 再手术(再手术), bleeding, 感染和卒中再手术的风险最低.