title: Functional outcomes after the Ross (pulmonary autograft) procedure assessed with magnetic resonance imaging and cardiopulmonary exercise testing.
abstract: OBJECTIVE
  To assess autograft, homograft and ventricular function, as well as exercise capacity, in adult patients who have undergone the Ross procedure.
  
  
  METHODS
  Single centre paediatric and adult congenital heart disease unit. Patients 45 subjects (24.6 years, range 16.9-52.2 years) who underwent the Ross procedure between 1994 and 2006 (8.1 years after the Ross operation, range 2.0-14.0 years). Interventions Cardiovascular magnetic resonance imaging, echocardiography and cardiopulmonary exercise testing.
  
  
  METHODS
  Autograft and homograft stenosis, and regurgitation. Autograft size. Biventricular function, scar volume and exercise capacity.
  
  
  RESULTS
  Mean autograft regurgitation was 6.8%+/-8.3% (trivial regurgitation) and diameter was 40.0+/-7.0 mm. Mean homograft velocity was 2.4+/-0.6 m/s (mild-moderate stenosis) and regurgitation was 6.1%+/-8.3% (trivial regurgitation). Biventricular systolic function was normal (LV EF 63.1+/-6.4% and RV EF 60.1%+/-7.6%). In 38% of cases there was evidence of LV scar, mostly noted within the inter-ventricular septum. The mean exercise capacity achieved was 87%+/-22% of predicted. There was no correlation between exercise capacity and ventricular function or scar.
  
  
  CONCLUSIONS
  This study demonstrates minor autograft and homograft dysfunction in the majority of patients after the Ross procedure, associated with good ventricular function and exercise capacity. In addition, minor scar was present in a third of patients with no functional consequences.
authors: Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK.
authors: Rajesh
authors: R
authors: Puranik
authors: Victor T
authors: VT
authors: Tsang
authors: Andrew
authors: A
authors: Broadley
authors: Johannes
authors: J
authors: Nordmeyer
authors: Phillip
authors: P
authors: Lurz
authors: Nagarajan
authors: N
authors: Muthialu
authors: Graham
authors: G
authors: Derrick
authors: Fiona
authors: F
authors: Walker
authors: Seamus
authors: S
authors: Cullen
authors: Marc
authors: M
authors: de Leval
authors: Phillip
authors: P
authors: Bonhoeffer
authors: Andrew M
authors: AM
authors: Taylor
authors: Vivek
authors: V
authors: Muthurangu
mesh_terms: D000293:Adolescent; D000328:Adult; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D002921:Cicatrix / Q000503:physiopathology; D025401:Echocardiography, Stress; D005080:Exercise Test; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D011475:Prosthesis Failure; D011664:Pulmonary Valve / Q000637:transplantation*; D012086:Reoperation; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D018487:Ventricular Dysfunction, Left / Q000209:etiology; D055815:Young Adult