title: Short-term follow up of the Ross operation in children.
abstract: OBJECTIVE
  Aortic valve disease in the pediatric population poses special problems to surgeons and cardiologists. The pulmonary autograft has proven to be a good alternative for aortic valve replacement and left ventricular outflow tract (LVOT) reconstruction in this special group.
  
  
  METHODS
  Forty-one children (mean age 10.0 +/- 4.8 (SD) years; range: 35 days to 18.8 years) underwent aortic root replacement with a pulmonary autograft between February 1994 and April 1998. Twenty-one patients (51%) had previous cardiac surgery; seven (17%) had balloon valvulotomy. Aortic root replacement was combined with other techniques for various disorders, including tunnel LVOT obstruction, ventricular septal defect (VSD)-aortic insufficiency complex, neoaortic insufficiency following arterial switch procedure, and subvalvular stenosis following correction of type B interruption of the aortic arch (IAA) with VSD (IAA-B/VSD).
  
  
  RESULTS
  The mean follow up was 1.7 +/- 1.0 years (range 44 days to 4.1 years). Total follow up time was 67.8 patient-years. Two patients, both after repair of interrupted aortic arch, died intraoperatively (4.9%). There was no late mortality. Two patients were reoperated on (5.1%), one for autograft insufficiency due to cuspal perforation and one for right ventricular outflow tract stenosis at the distal anastomosis. Thirty-eight patients (97%) are currently in NYHA class I; one child with a preoperatively poor left ventricular function did not improve and is in class II. At the latest echocardiographic follow up, neoaortic regurgitation was absent in 19% of patients, trivial in 69% and mild in 11%. Homograft insufficiency was absent in 64%, trivial in 31% and mild in 6%. All mean gradients for both autograft and homograft were < 15 mmHg.
  
  
  CONCLUSIONS
  The Ross operation can be performed with good results in infants and children with different forms of LVOT obstruction and aortic insufficiency, though aortic stenosis following IAA-B/VSD repair poses a surgically difficult problem.
authors.affiliation: Department of Cardiothoracic Surgery, Leiden University Medical Center, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Braun
authors.forename: M G
authors.initials: MG
authors.lastname: Hazekamp
authors.forename: P H
authors.initials: PH
authors.lastname: Schoof
authors.forename: J
authors.initials: J
authors.lastname: Ottenkamp
authors.forename: H A
authors.initials: HA
authors.lastname: Huysmans
mesh_terms: D000293:Adolescent; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D012086:Reoperation; D014694:Ventricular Outflow Obstruction / Q000601:surgery*