{"id":5382,"date":"2025-04-02T00:00:47","date_gmt":"2025-04-02T00:00:47","guid":{"rendered":"https:\/\/www.heart-valve-surgery.com\/learning\/?page_id=5382"},"modified":"2025-05-19T15:27:30","modified_gmt":"2025-05-19T15:27:30","slug":"inspecting-pulmonary-valve-ross-procedure","status":"publish","type":"page","link":"https:\/\/www.heart-valve-surgery.com\/learning\/inspecting-pulmonary-valve-ross-procedure\/","title":{"rendered":"Surgeon Q&#038;A: Inspecting the Pulmonary Valve During the Ross Procedure"},"content":{"rendered":"<p>The <a href=\"https:\/\/www.heart-valve-surgery.com\/ross-procedure-aortic-disease\">Ross Procedure<\/a>, which has seen a resurgence in recent years due to reports of better long-term outcomes and surgical refinements, replaces the aortic valve with the patient\u2019s pulmonary valve. A homograft, or donor valve, is then used in its place. That said, the Ross Procedure is a very complicated \u201ctwo-valve\u201d operation.<\/p>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-5389 aligncenter\" src=\"https:\/\/www.heart-valve-surgery.com\/learning\/..\/Images\/ross-procedure-drawing.jpg\" alt=\"Ross Procedure Drawing\" width=\"650\" height=\"361\" \/><\/p>\n<p>&nbsp;<\/p>\n<p>Surgeons perform extensive pre-procedure testing to ensure patients are suitable candidates before entering the operating room. Specific tests evaluate the pulmonary valve to determine if that valve will be durable enough to withstand the high pressures in the aortic valve position. Although testing is comprehensive, what happens if the surgeon can\u2019t use the pulmonary valve once the procedure has begun?<\/p>\n<p>I met with <a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-William-Brinkman-Plano-Texas.php\">Dr. William Brinkman<\/a> to gain insight into this critical aspect of the Ross Procedure while we were at the Society of Thoracic Surgeons Conference. Dr. Brinkman is a leading aortic valve surgeon at Baylor Scott &amp; White The Heart Hospital-Plano in Plano, Texas who specializes in the Ross Procedure.<\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/LNOC-od0cts?rel=0?si=JASDnxPDFz-RfA1U\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n<p>&nbsp;<\/p>\n<h2>Inspecting the Pulmonary Valve<\/h2>\n<p>Here are key insights shared by Dr. Brinkman:<\/p>\n<ul>\n<li>When doing a Ross Procedure, is it often, seldom, or rare that a pulmonary valve won\u2019t fit or work in the aortic position? \u201cI would say it is seldom,\u201d said Dr. Brinkman. \u201cBut it happens. We do a lot of testing beforehand, like an echocardiogram and a cardiac CT to look at the size of the pulmonary valve and the aortic annulus. We also try to look at the leaflets. We look at how the pulmonary valve is working. But even with that, in our series, I would say about a 10 percent chance.\u201d<\/li>\n<li>Fenestrations, or holes in the pulmonary valve leaflets, may be problematic for long-term durability. \u201cWhen we look down at those leaflets, we might see some fenestrations, or holes, that don\u2019t affect its function in a low-pressure system like the pulmonary position,\u201d stated Dr. Brinkman. But if you moved it into the high-pressure system, we worry it wouldn\u2019t last long. In that situation, we may bail on the Ross Procedure. I would say it happens about 10 percent of the time.\u201d<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-5392 aligncenter\" src=\"https:\/\/www.heart-valve-surgery.com\/learning\/..\/Images\/leaflet-fenistrations-heart-valve.jpg\" alt=\"Heart Valve Leaflet Fenestrations\" width=\"650\" height=\"360\" \/><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>It is a \u201cgame-time\u201d decision that can\u2019t be made by looking at imaging but rather in the operating room. Dr. Brinkman said, \u201cBecause these leaflets are very thin, it\u2019s almost like a flag in the wind, and you need to take a close look at it. The best CT scans and echocardiogram still can\u2019t quite give us that resolution yet.\u201d<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h2>Thank you, Dr. Brinkman and Baylor Scott &amp; White!<\/h2>\n<p>On behalf of all the patients in our community, thank you, <a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-William-Brinkman-Plano-Texas.php\">Dr. William Brinkman<\/a>, for everything you and your team are doing at Baylor Scott &amp; White in Plano, Texas!<\/p>\n<p>Related links:<\/p>\n<ul>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/learning\/ross-procedure-reoperations-research\/\">Ross Procedure Research Alert: Durability &amp; Reoperations with Dr. Bill Brinkman<\/a><\/li>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/ross-procedure-aortic-disease\">New Ross Procedure Patient Education Center<\/a><\/li>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/learning\/bicuspid-aortic-valve-aneurysm-treatment\/\">Surgeon Q&amp;A: Treating Bicuspid Aortic Valves &amp; Aortic Aneurysms<\/a><\/li>\n<\/ul>\n<p>Keep on tickin,<\/p>\n<p>Adam<\/p>\n<p>P.S. For the deaf and hard-of-hearing members of our patient community, we have provided a written transcript of our interview with Dr. Brinkman below.<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":4,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"cms.php","meta":{"_acf_changed":false,"footnotes":""},"categories":[16],"class_list":["post-5382","page","type-page","status-publish","hentry","category-ross-procedure"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/5382","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/comments?post=5382"}],"version-history":[{"count":16,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/5382\/revisions"}],"predecessor-version":[{"id":5812,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/5382\/revisions\/5812"}],"wp:attachment":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/media?parent=5382"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/categories?post=5382"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}