Melody valve after Ross Procedure

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bentas

New member
Joined
Apr 21, 2016
Messages
1
Location
Victoria Australia
Hi everyone,

Thank you for taking the time to read my short heart valve replacement story, and my questions about the implantation of a Melody Valve after a Ross Procedure.

I underwent a Ross Procedure in 2003 for congenital aortic stenosis.

At the time of the surgery I was 26 years of age, and I am now 39. The procedure took place at the Epworth Hospital, where my surgeon was the talented and professional Mr Peter Skillington.

Immediately post surgery, my pulmonary valve gradient increased, and was monitored for several months to ensure re-operation would not be required.

Thankfully, the gradient plateaued and I was able to resume physical activity and had a wonderful period of freedom and quality of life after my Ross Procedure.

I undertook a range of aerobic activities and also some moderate weight work at the gym, without any shortness of breath or other symptoms. I had echos every two years, which indicated the pulmonary value was showing signs of wear, but not cause for alarm.

Around 4 years ago, I started to notice that I was feeling sluggish when exercising, and my aerobic capacity was dropping dramatically, despite being otherwise fit and healthy. I undertook a stress echo, which confirmed that my pulmonary valve was not coping with the demands of exercise – the gradient was increasing significantly (to a mean gradient of 20mmHg) under stress, and the right ventricle became mildly to moderately dilated.

The cardiologist who ran the stress echo suggested I should cap my heart rate at 150BPM when exercising, which required some lifestyle changes– when jogging, for example, my heart rate is typically in the 160’s. Over the last 5 years, the pulmonary valve leakage has progressed from a 'trivial' leak, to a 'mild' leak to what is now a 'moderate' leak, and my exercise is limited to walking.

Mr Skillington has advised that his criteria to replace the pulmonary valve are:
  1. Increase in resting RV size of significance or reduced RV contractility test; or
  2. Resting mean gradient exceeding 40mm.Hg
I have a normal RV size and function at rest, and a mean gradient at rest of between 20-24mm.Hg. Therefore I do not meet either of these criteria, and surgery would be a personal decision based on my desire for a more active lifestyle. If I elected to have surgery, Mr Skillington advised that he would replace the pulmonary valve with a porcine root prosthesis.

My questions to the forum relate to an alternative solution – the Melody Valve. In my appointments with Mr Skillington, we did not discuss the Melody Valve in detail, and I was hoping to first educate myself by engaging with the forum and asking some questions:
  • Has anyone had the Melody valve implanted after a Ross procedure? What could you share with me about that experience?
  • Is a Ross procedure pulmonary homograft a viable recipient of a melody implant? What might be the criteria for determining suitability?
  • What are the key risks would I should consider in receiving a melody valve after a Ross procedure?
  • Where might I be able to find further information about implanting a melody valve for my post-Ross pulmonary valve? Is there anyone I could speak with about their experience (practitioner or recipient)?
I consider myself very fortunate to have had the Ross Procedure and would gladly make the decision to do so again. As I enter a new phase in my life, I would like to explore how I can regain the active lifestyle that brings so much joy to me, and your advice and ideas are greatly appreciated.

Thank you!
 
Hi everyone,

Thank you for taking the time to read my short heart valve replacement story, and my questions about the implantation of a Melody Valve after a Ross Procedure.

I underwent a Ross Procedure in 2003 for congenital aortic stenosis.

At the time of the surgery I was 26 years of age, and I am now 39. The procedure took place at the Epworth Hospital, where my surgeon was the talented and professional Mr Peter Skillington.

Immediately post surgery, my pulmonary valve gradient increased, and was monitored for several months to ensure re-operation would not be required.

Thankfully, the gradient plateaued and I was able to resume physical activity and had a wonderful period of freedom and quality of life after my Ross Procedure.

I undertook a range of aerobic activities and also some moderate weight work at the gym, without any shortness of breath or other symptoms. I had echos every two years, which indicated the pulmonary value was showing signs of wear, but not cause for alarm.

Around 4 years ago, I started to notice that I was feeling sluggish when exercising, and my aerobic capacity was dropping dramatically, despite being otherwise fit and healthy. I undertook a stress echo, which confirmed that my pulmonary valve was not coping with the demands of exercise – the gradient was increasing significantly (to a mean gradient of 20mmHg) under stress, and the right ventricle became mildly to moderately dilated.

The cardiologist who ran the stress echo suggested I should cap my heart rate at 150BPM when exercising, which required some lifestyle changes– when jogging, for example, my heart rate is typically in the 160’s. Over the last 5 years, the pulmonary valve leakage has progressed from a 'trivial' leak, to a 'mild' leak to what is now a 'moderate' leak, and my exercise is limited to walking.

Mr Skillington has advised that his criteria to replace the pulmonary valve are:
  1. Increase in resting RV size of significance or reduced RV contractility test; or
  2. Resting mean gradient exceeding 40mm.Hg
I have a normal RV size and function at rest, and a mean gradient at rest of between 20-24mm.Hg. Therefore I do not meet either of these criteria, and surgery would be a personal decision based on my desire for a more active lifestyle. If I elected to have surgery, Mr Skillington advised that he would replace the pulmonary valve with a porcine root prosthesis.

My questions to the forum relate to an alternative solution – the Melody Valve. In my appointments with Mr Skillington, we did not discuss the Melody Valve in detail, and I was hoping to first educate myself by engaging with the forum and asking some questions:
  • Has anyone had the Melody valve implanted after a Ross procedure? What could you share with me about that experience?
  • Is a Ross procedure pulmonary homograft a viable recipient of a melody implant? What might be the criteria for determining suitability?
  • What are the key risks would I should consider in receiving a melody valve after a Ross procedure?
  • Where might I be able to find further information about implanting a melody valve for my post-Ross pulmonary valve? Is there anyone I could speak with about their experience (practitioner or recipient)?
I consider myself very fortunate to have had the Ross Procedure and would gladly make the decision to do so again. As I enter a new phase in my life, I would like to explore how I can regain the active lifestyle that brings so much joy to me, and your advice and ideas are greatly appreciated.

Thank you!
Hi Bentas,
How did this turn out in the end?
 
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