Ross Procedure

罗斯手术是一种治疗病变主动脉瓣的手术. One of the heart's four valves, 主动脉瓣控制富含氧气的血液流向身体. If the valve becomes narrowed, a condition known as aortic stenosis, the heart has to work harder to pump, 导致肌肉增厚，并可能导致心力衰竭. If the aortic valve becomes leaky, a condition known as valve regurgitation, blood can back up into the heart, which also can eventually cause heart failure.

这两种情况的标准治疗方法都是用一个机械的(由耐用材料制成的)假体代替故障瓣膜, such as titanium) or made from animal tissue. But neither is a perfect solution. Tissue valves wear out and have to be replaced, while mechanical valves are prone to blood clots, 也就是说患有这种疾病的病人在他们的余生中都要服用血液稀释药物.

The Ross procedure provides another option. 外科十大赌博平台排行榜用病人自己的另一个心脏瓣膜替换病变的瓣膜, the pulmonary valve. 这种交换是有效的，因为肺动脉瓣的形状相似，可以变得足够厚和坚固，像主动脉瓣一样起作用. 接着，肺动脉瓣会被来自尸体捐献者的瓣膜所取代.

对于某些患者，罗斯手术比标准瓣膜置换术有很多优点. Although it's a more complicated surgery, the procedure has a lower risk of infection, bleeding, clotting and stroke. 没有瓣膜与病人的解剖结构不匹配的风险——这是人工瓣膜的常见问题. Also, 这种瓣膜比动物组织义肢更耐用，而且不需要患者服用血液稀释药物.

These advantages are most meaningful for younger patients. Elderly patients (those over 70) generally fare well with prosthetic valve replacements; the treatment nearly restores their normal life expectancy. 然而，在60岁及以下的患者中，使用标准的瓣膜置换术会缩短预期寿命. 罗斯手术是唯一一种能使年轻患者恢复正常预期寿命的主动脉瓣置换术.

Who may benefit

罗斯手术适用于患有主动脉瓣疾病但没有其他重大疾病的年轻患者, such as significant liver, kidney or lung disease. 我们一般只对60岁左右及以下的人做这个手术.

Others who may benefit from the procedure include:

Women who plan to have children
先前主动脉瓣置换术后瓣膜失效的患者
主动脉瓣很小需要更换的患者(通常是妇女和儿童)

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, coronary artery or mitral valve disease.

Advantages

Ross程序相对于标准阀门更换的优点包括:

The valve lasts longer than an animal tissue valve.
Compared to a tissue valve, 重新安置的瓣膜术后因钙化(钙沉积引起的组织硬化)而恶化的风险较低。.
No need to take blood thinners (unlike with mechanical valves).
Decreased risk of valve infection, bleeding or stroke.
Decreased chance that the body will reject the valve.
Easier blood flow regulation.
Restores normal life expectancy to patients under 60.

Evaluation

To determine whether you're a candidate for the Ross procedure, 你的十大赌博平台排行榜会评估你的主动脉瓣状况和整体心血管健康状况, generally with the help of one or more of the following tests:

Echocardiogram. Also called a heart ultrasound, 这种无创测试使用声波产生心脏的详细图像, 使十大赌博平台排行榜能够评估其腔室和瓣膜的结构，并观察血液流动. In a transthoracic echocardiogram, 通过在胸部和腹部的不同位置放置换能器(发射声波的装置)来捕获图像. In a transesophageal echocardiogram, a thin tube conveys a transducer down the esophagus, allowing doctors to obtain images from inside the body.
Coronary CT angiogram. 这种非侵入性检查使用x射线成像胸腔血管, including the aorta and the pulmonary artery.
Coronary angiogram. A catheter (a thin, 柔性管)穿过手腕或腹股沟的血管连接到心脏的动脉, 然后将一种无害的染料注射到导管中，这种染料在x射线上显示得很好. 该测试提供了详细的图像，显示冠状动脉的功能如何，也允许十大赌博平台排行榜测量心脏腔内的压力.

Procedure

罗斯手术是开胸手术，需要全身麻醉(你完全睡着了)。. The surgeon cuts through the breastbone to access your heart. Because your heart must be temporarily stopped, you are placed on a heart-lung bypass machine, which keeps the blood circulating through your body. The surgeon inspects and removes the diseased aortic valve, 然后检查肺动脉瓣，以确保它是一个健康和合适的替代品. 如果是，瓣膜将被移除并植入主动脉瓣. The surgeon then implants a donor pulmonary valve. The operation typically takes four to five hours.

Recovery

Expect to spend five to seven days in the hospital, the first two or three of those in intensive care. We encourage you to be up and walking within 24 hours of the surgery; most patients are able to do so. During your post-op stay, 进行后续检查以确定你的心脏瓣膜是否正常工作. 这些检查包括胸部x光、血液检查、心电图和超声心动图.

Before you go home, 你的心脏护理团队会和你讨论如何照顾自己, providing instructions on diet, exercise, care of your incision site, and use of current or new medications.

我们建议你在手术恢复期间进行六周的限制活动. 在这段时间里，我们可能还会开出某些药物，包括:

利尿剂(增加排尿的药物)，所以你不会保留水分
Pain medicine, in gradually decreasing amounts
当你的肺动脉瓣“学习”如何成为主动脉瓣时，-受体阻滞剂可以帮助你保持低血压
ACE (angiotensin-converting enzyme) inhibitors, 为了额外的血压控制或者如果你有严重的瓣膜反流和左心室扩张

Risks

Though the Ross procedure's results hold up well over time, 每年大约有1%的几率需要进行另一次手术来修复主动脉或肺动脉瓣的问题. (这比组织瓣膜治疗要好，但比机械瓣膜治疗更频繁.) About half the time, we can address the problem without open-heart surgery, and half the time, patients need another open-heart surgery. However, 主动脉瓣手术后可能出现的四种主要并发症之一是, reoperation (having another surgery), bleeding, infection and stroke – reoperation has the lowest risk.