Preliminary results following reinforcement of the pulmonary autograft to prevent dilatation after the Ross procedure

OBJECTIVE: The Ross operation remains a controversially discussed procedure, because concern exists regarding late dilatation of the neoaortic root and progressive regurgitation of the autograft valve. We present our early experience with an external reinforcement of the autograft, which is inserted into a prosthetic Dacron graft with an artificial aortic root configuration. This detail should help to prevent neoaortic root dilatation. PATIENTS AND METHODS: Between 2006 and 2007, 12 patients (mean age 16 +/- 38 years; range 15-38 years) underwent a Ross procedure by this technique. Indications were aortic regurgitation (n = 2), aortic stenosis (n = 5), and combined aortic stenosis and insufficiency (n = 5). A bicuspid aortic valve was present in 9 patients. Balloon valvuloplasty had been performed in 7 patients. Follow-up was performed by clinical and echocardiographic examinations. RESULTS: No early or late deaths occurred in this small series, and freedom from reoperation is 100%. Echocardiographic follow-up confirmed absence of aortic insufficiency in 11 patients after a mean of 11 months (range 2-30 months). In 1 patient, a small asymmetric regurgitation jet was already observed at discharge echocardiography. As expected, no neoaortic root dilatation was observed during follow-up. All patients are in New York Heart Association class I. CONCLUSIONS: The present technique is a simple and reproducible technical step that does not require significant additional time. Inclusion of the autograft within a root prosthesis may be especially indicated in situations known for late autograft dilatation, namely, bicuspid aortic valve, predominant aortic insufficiency, and ascending aortic enlargement.

The Ross procedure in infants and young children

BACKGROUND: This study reviews our experience with the Ross procedure in infants and young children. METHODS: From September 1993 to September 2004, 52 children less than 15 years of age underwent a Ross procedure. The patients ranged in age from 4 days to 15 years old (median, 5 years). Fifteen patients (29%) were less than 2 years of age. The predominant indication for the Ross procedure was aortic stenosis. Sixteen patients underwent a Ross-Konno procedure for severe left ventricular outflow tract obstruction. Thirty-four patients had 48 previous interventions. Preoperatively, 6 patients showed severe left ventricular dysfunction, and 2 of the patients required ventilation and inotropic support. Concomitant procedures were performed in 8 patients. Three patients had a mitral valve replacement, 2 patients had a ventricular septal defect closure and an aortic arch reconstruction, 2 patients had aortic arch reconstructions, and 1 patient had resection of a coarctation and a ventricular septal defect closure. RESULTS: Patients were followed up for a median of 43 months (range, 1 to 130). Overall survival was 85% +/- 5% at 1 and 82% +/- 5% at 2, 5, and 10 years. Hospital mortality was 5 of 52 patients (9.6%). All deaths occurred in neonates or infants less than 2 months of age, who needed urgent surgery. Three patients died late of noncardiac causes. At last follow-up, all patients were classified in New York Heart Association functional class I or II. No patient had endocarditis of the autograft or the right ventricular outflow tract replacement. During the follow-up, no event of thrombembolism was observed. No patient required the insertion of a permanent pacemaker. Overall freedom from reoperation is 57% +/- 15% at 10 years. One patient required the replacement of the autograft at 6 months postoperatively. The development of mild aortic insufficiency was observed in 24 patients, and moderate aortic insufficiency in 1 patient during follow-up. Freedom from reoperation for the right ventricular outflow tract replacement is 60% +/- 15% at 10 years. CONCLUSIONS: The Ross procedure represents an attractive approach to aortic valve disease in young children. However, a high early mortality rate has to be considered when performing this procedure in neonates or infants who present in critical preoperative condition.

Fracture and Back Stress Along the Byrd Glacier Flowband on the Ross Ice Shelf

East Antarctic ice discharged by Byrd Glacier continues as a flowband to the calving front of the Ross Ice Shelf. Flow across the grounding line changes from compressive to extensive as it leaves the fjord through the Transantarctic Mountains occupied by Byrd Glacier. Magnitudes of the longitudinal compressive stress that suppress opening of transverse tensile cracks are calculated for the flowband. As compressive back stresses diminish, initial depths and subsequent growth of these cracks, and their spacing, are calculated using theories of elastic and ductile fracture mechanics. Cracks are initially about one millimeter wide, with approximately 30 in depths and 20 in spacings for a back stress of 83 kPa at a distance of 50 kin beyond the fjord, where floating ice is 600 in thick. When these crevasses penetrate the whole ice thickness, they release tabular icebergs 20 kin to 100 kin wide, spaced parallel to the calving front of the Ross Ice Shelf

Monsoonal Circulation of the McMurdo Dry Valleys, Ross Sea Region, Antarctica: Signal from the Snow Chemistry

McMurdo Dry Valleys (MDV, Ross Sea region, Antarctica) precipitation exhibits extreme seasonality in ion concentration, 3-5 orders of magnitude between summer and winter precipitation. To identify aerosol sources and investigate causes for the observed amplitude in concentration variability, four snow pits were sampled along a coast-Polar Plateau transect across the MDV. The elevation of the sites ranges from 50 to 2400 m and the distance from the coast from 8 to 93 km. Average chemistry gradients along the transect indicate that most species have either a predominant marine or terrestrial source in the MDV. Empirical orthogonal function analysis on the snow-chemistry time series shows that at least 57% of aerosol deposition occurs concurrently. A conceptual climate model, based on meteorological observations, is used to explain the strong seasonality in the MDV. Our results suggest that radiative forcing of the ice-free valleys creates a surface low-pressure cell during summer which promotes air-mass flow from the Ross Sea. The associated precipitating air mass is relatively warm, humid and contains a high concentration of aerosols. During winter, the MDV are dominated by air masses draining off the East Antarctic ice sheet, that are characterized by cold, dry and low concentrations of aerosols. The strong differences between these two air-mass sources create in the MDV a polar version of the monsoonal flow, with humid, warm summers and dry, cold winters.

Colin Ross: Der Weg nach Osten [Rezension]

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Colin Ross: Die Welt auf der Waage [Rezension]

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Colin Ross: Der unvollendete Kontinent ... [Rezension]

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Sand geochemistry on sediment core CRP-3 from the Ross Sea, Antarctica

A total of 167 samples distubuted throughout the CRP-3 drillhole from 5.77 to 787.68 mbsf and representing fine to coarse sandstones have been analysed by X-ray fluorescence spectrometry (XRF) Bulk sample geochemistry (major and trace elements) indicates a dominant provenance of detritus from the Ferrar Supergroup in the uppermost 200 mbsf of the core. A markedly increased contribution from the Beacon sandstones is recognized below 200 mbsf and down to 600 mbsf. In the lower part of CRP-3, down to 787.68 mbsf, geochemical evidence for influxes of Ferrar materials is again recorded. On the basis of preliminary magnetostratigraphic data reported for the lower 447 mbsf of the drillhole, we tentatively evaluated the main periodicities modulating the geochemical records. Our results identify a possible influence of the precession, obliquity and long-eccentricity astronomical components (21, 41, and 400 ky frequency bands) on the deposition mechanisms of the studied glaciomarine sediments.

Investigation of Quaternary diatoms in sediment core CRP-1 from the Ross Sea, Antarctica

In the first season of drilling, the Cape Roberts Project (CRP) recovered one drillcore (CRP-l) from Roberts Ridge in western McMurdo Sound, Ross Sea, Antarctica Diatom biostratigraphy places the upper six lithostratigraphic units (Units 1.1, 2.1, 2.2, 2.3, 3.1, and 4.1) of CRP-l (0.0 to 43.15 mbsf) within the Quaternary. Both non-marine and marine Quaternary diatoms occur in variable abundance in the Quaternary interval of CRP- 1 Biostratigraphic data resolve two Quaternary time slices or events within CRP-1. Marine diatom assemblages in Units 4.1 and 3.1 represent sedimentation within the diatom Actinocyclus ingens Zone (1.35 to 0.66 Ma). Further refinement of the age of Unit 3.l places deposition in the interval 1.15 to 0.75 Ma based on the common occurrence of Thalassiosira elliptipora and correlation to the Southern Ocean acme of this taxon The absence of ActiActinocyclus ingens and the presence ot Thalassiosira antarctica in Unit 2.2 require a younger zonal assignment for this interval, within the diatom Thalassiosira lentiginosa Zone (0.66 to 0.0 Ma). A new diatom species. Rouxia leventerae, is described from marine assemblages of Units 2.2, 2.3, 3.1, and 4.l. Lithostratigraphic Unit 3.1 (33.82 to 31.89 mbsf) is a bryozoan-dominated skeletal-carbonate facies. Low abundance of Fragilariopsis curta and Fragilariopsis cylindrus within this unit combined with the relatively high abundance of species associated with open water indicates deposition in waters that remained ice free for much or all of the year Diatom assemblages suggest carbonate deposition in Unit 3.1 is linked to a significant early Pleistocene event in McMurdo Sound, when elevated surface-water temperatures inhibited the formation of sea ice.

Geochemical investigations of elements in sediment core CRP-1 from the Ross Sea, Antarctica

Geochemical data are presented for samples from strata, mainly of Miocene age, in the Cape Roberts-1 core (western McMurdo Sound, Antarctica) to assess the sediment provenance. Bulk (major and trace element) chemistry together with bulk mineralogy of fine-grained sandstones, siltstones, mudstones, and diamictites indicate that chemical alteration of source materials, fractionation due to sedimentary sorting, and diagenetic effects were not significant in the Cape Roberts sediment history. Relevant geochemical parameters are consistent with the Cape Roberts sediments being derived mainly from the crystalline basement and the Beacon Supergroup. On the basis of element distributions, an additional contribution from the Ferrar Dolerite and, mainly above about 60 m, influxes of detritus derived from basanitic to intermediate members of the McMurdo Volcanic Group are recognised.