title: Size and distensibility of the aortic root and aortic valve function after different techniques of the ross procedure.
abstract: OBJECTIVE
  In the Ross procedure, 3 different techniques are used for aortic valve replacement with the pulmonary autograft: freestanding root, inclusion, and subcoronary implantation. The objective of this study was to evaluate echocardiographically the influence of the particular operative technique on dimension, distensibility, and valve function.
  
  
  METHODS
  Between February 1990 and August 1998, the Ross procedure was performed in 111 patients (mean age, 48.6 +/- 14.1 years; range, 15.2-70.6 years), with 1 early and 1 late death, 1 autograft replacement, and 1 patient lost to follow-up. The remaining patients underwent the freestanding root (n = 9 patients), inclusion (n = 14 patients), and subcoronary techniques (n = 84 patients). Echocardiography was performed at a mean follow-up of 26 +/- 21.3 months after operation and was compared with the echocardiographic findings of the control subjects (n = 10 subjects). Root sizes were measured at the level of the anulus, sinus, and supra-aortic ridge; the distensibility was calculated as pressure strain elastic modulus and percent change of radius.
  
  
  RESULTS
  Size and distensibility of the aortic root were normal, except for a larger diameter at the sinus level in the root technique in comparison to the subcoronary technique (P <.05; maximum diameter, 41.3 +/- 8.6 mm vs 32.6 +/- 4.0 mm). Aortic valve function was comparable among groups with low pressure gradients and most patients with no or trace aortic insufficiency.
  
  
  CONCLUSIONS
  The freestanding root, inclusion, and subcoronary techniques in the Ross procedure provide comparable excellent hemodynamics, normal root size, and distensibility, except for the enlarged sinus diameter in the freestanding root. These results may have some impact on the operative procedure and follow-up investigations.
authors.affiliation: Departments of Cardiac Surgery and Anesthesiology, Medical University of Luebeck, Luebeck, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Schmidtke
authors.forename: J f
authors.initials: Jf
authors.lastname: Bechtel
authors.forename: M
authors.initials: M
authors.lastname: Hueppe
authors.forename: A
authors.initials: A
authors.lastname: Noetzold
authors.forename: H H
authors.initials: HH
authors.lastname: Sievers
mesh_terms: D000328:Adult; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000502:physiology*; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000502:physiology / Q000601:surgery; D018618:Echocardiography, Doppler, Color; D004548:Elasticity; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011664:Pulmonary Valve / Q000637:transplantation; D012189:Retrospective Studies; D014184:Transplantation, Homologous / Q000502:physiology; D016896:Treatment Outcome; D014741:Video Recording