MR imaging of right ventricular function after the Ross procedure for aortic valve replacement: initial experience.
OBJECTIVE
To prospectively assess right ventricular (RV) function after the Ross procedure by using magnetic resonance (MR) imaging.


METHODS
The local ethics committee approved the study and informed consent was obtained from all participants prior to enrollment in the study. Seventeen patients (15 male, two female; mean age +/- standard deviation, 19 years +/- 3.9; imaging performed 8.3 years after surgery +/- 3.2) and 17 matched controls (15 male, two female; mean age +/- standard deviation, 20 years +/- 3.9) were studied by using MR imaging. Standard velocity-encoded and multisection multiphase imaging sequences were used to assess homograft valve function, systolic and diastolic RV function, and RV mass. The two-tailed Mann-Whitney U test and the Spearman rank correlation coefficient were used for statistical analysis.


RESULTS
Minor degrees of homograft stenosis (peak flow velocity between 1.5 and 3.0 m/sec across the homograft valve) were found in 12 of 17 patients but not in controls (P < .001). A larger RV mass was present in Ross patients than in controls (17.0 g/m(2) +/- 4.8 vs 10.9 g/m(2) +/- 5.6, P = .004). In addition, impaired diastolic RV function was found, as shown by a decreased mean tricuspid valve early filling phase-atrial contraction phase (E/A) peak flow velocity ratio (1.56 +/- 0.75 vs 2.05 +/- 0.58, P = .03). Peak flow velocity across the homograft valve correlated with RV mass (r = 0.38, P = .03) and tricuspid valve E/A peak flow velocity ratio (r = 0.39, P = .02). RV systolic function was normal in Ross patients (mean RV ejection fraction, 52% +/- 8 vs 51% +/- 5; P = .74).


CONCLUSIONS
RV hypertrophy and RV diastolic dysfunction are frequently observed in patients after the Ross procedure, even in the absence of overt homograft stenosis. RV systolic function is still preserved.
Department of Radiology, Leiden University Medical Center, Albinusdreef 2, C2-S, 2300 RC Leiden, the Netherlands.
Heynric B
HB
Grotenhuis
Albert
A
de Roos
Jaap
J
Ottenkamp
Paul H
PH
Schoof
Hubert W
HW
Vliegen
Lucia J M
LJ
Kroft
D000328:Adult; D001011:Aorta / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000175:diagnosis* / Q000209:etiology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D010865:Pilot Projects; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000209:etiology*