title: Does intraoperative transesophageal echocardiography predict pulmonary valve dysfunction during the Ross procedure?
abstract: OBJECTIVE
  To determine the value of intraoperative transesophageal echocardiography for the assessment of the pulmonary valve anatomy and the pulmonary autograft performance in patients undergoing the Ross procedure.
  
  
  METHODS
  Open, prospective, observational survey.
  
  
  METHODS
  Favaloro Foundation, single institution.
  
  
  METHODS
  Consecutive patients undergoing elective Ross procedure (n = 87).
  
  
  METHODS
  Pulmonary valve function and anatomy were assessed by transesophageal echocardiography and the surgeon. Pulmonary autograft function was assessed after implantation. Regurgitation was considered mild (+/4), moderate (++/4), moderate-to-severe (+++/4), and severe (++++/4). Patients were restudied during midterm follow-up.
  
  
  RESULTS
  The Ross procedure was done in 74 patients (85%). Overall mortality was 3.4%. Mean follow-up was 24 +/- 13 months. The Ross procedure was not done in 13 patients (15%): 6 patients had a bicuspid pulmonary valve, 6 patients had >3 mm fenestrations, and 1 patient had regurgitation. The surgeon diagnosed anomalies in the pulmonary valve through direct observation. Transesophageal echocardiography was not sensitive enough to diagnose pulmonary valve defects in 12 of 13 patients with anomalies. Pulmonary valve regurgitation was identified by intraoperative transesophageal echocardiography in only 1 patient. Autograft regurgitation was 1.07 +/- 0.35 at postoperative evaluation. At 1, 6, and 12 months, it was 1.25 +/- 0.7 (p = 0.18), 1.27 +/- 0.9 (p = 0.185), and 1.29 +/- 0.8 (p = 0.17). The difference in values was not statistically significant. Four patients (5.4%) showed an increase in regurgitation during the first transthoracic autograft control.
  
  
  CONCLUSIONS
  Intraoperative transesophageal echocardiography allows assessment of autograft performance after implantation. This method is not helpful, however, in detecting pulmonary valve anatomic anomalies.
authors.affiliation: Department of Cardiovascular Surgery, Section of Anesthesiology and Heart Valve Disease, Favaloro Foundation, Buenos Aires, Argentina. pstutzback@ffavaloro.org
authors.forename: Carmen B
authors.initials: CB
authors.lastname: Gomez
authors.forename: Pablo G
authors.initials: PG
authors.lastname: Stutzbach
authors.forename: Eduardo
authors.initials: E
authors.lastname: Guevara
authors.forename: Roberto R
authors.initials: RR
authors.lastname: Favaloro
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000637:transplantation*; D011665:Pulmonary Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome