Neoaortic root diameters and aortic regurgitation in children after the Ross operation.
BACKGROUND
For children who require aortic valve replacement, the Ross operation provides a unique advantage of growth potential of the pulmonary autograft in the aortic position. This study assessed the progression of autograft root diameters and its effect on aortic regurgitation (AR).


METHODS
Neoaortic echo dimensions from 48 children (<16 years) undergoing Ross operation who had follow-up echocardiograms before age 20 were analyzed (mean follow-up, 5.1 +/- 3.3 years).


RESULTS
The mean age at the time of the Ross operation was 10.0 +/- 4.3 years. Mean z values of the neoaortic annulus (1.5 +/- 0.4), sinus (2.5 +/- 0.4), and sinotubular junction (2.6 +/- 0.9) when the autograft was implanted were significantly larger compared with normal values (p < 0.001, all). The mean z values significantly increased with follow-up at the level of the sinus (0.5 +/- 0.1/year, p < 0.001) and the sinotubular junction (0.7 +/- 0.2, p < 0.001), but not at the level of the annulus (0.1 +/- 0.1, p = 0.59). AR increased with follow-up time (0.07 +/- 0.02 grade/year, p < 0.001). AR increased with sinotubular junction diameter (p = 0.028), but there was not significant evidence of an association with annulus diameter (p = 0.25) or sinus diameter (p = 0.40).


CONCLUSIONS
Children undergoing Ross operation have larger neoaortic root dimensions than healthy children. Growth of the annulus matches somatic growth. The diameters of the sinus and the sinotubular junction increase significantly relative to somatic growth. The latter may explain the development of AR.
Hörer
Jürgen
J
Department of Cardiovascular Surgery, German Heart Center Munich at Technical University, Munich, Germany. hoerer@dhm.mhn.de
Hanke
Thorsten
T
Stierle
Ulrich
U
Takkenberg
Johanna J M
JJ
Bogers
Ad J J C
AJ
Hemmer
Wolfgang
W
Rein
Joachim G
JG
Hetzer
Roland
R
Hübler
Michael
M
Robinson
Derek R
DR
Sievers
Hans H
HH
Lange
Rüdiger
R
D000293:Adolescent; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology; D001830:Body Surface Area; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D004108:Dilatation, Pathologic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011184:Postoperative Period; D011664:Pulmonary Valve / Q000637:transplantation*; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D014463:Ultrasonography