title: Exercise stress echocardiography after childhood Ross surgery: functional outcome in 26 patients from a single institution.
abstract: Adult studies suggest a better functional outcome after aortic valve replacement with a pulmonary autograft compared with mechanical or homograft valves. Little is known about functional results after Ross surgery in growing children. This study reports formal exercise stress echocardiographic data from 26 pediatric Ross patients. A retrospective cohort study analyzed stress echocardiographic data of patients who underwent Ross surgery as a child (<17 years old). All patients were operated by a single surgeon and underwent a Bruce protocol stress echocardiogram on the treadmill. Twenty-six patients (4 girls) were 9.3 ± 5.0 years at surgery and 14.9 ± 3.5 years (range 6.6-19.7 years) at follow-up. Mean follow-up was 5.4 ± 3.7 years (median 4.2). All were asymptomatic. The exercise time was normal in 87% of cases at 12.8 ± 2.5 min. On stress echocardiography, the mean right-ventricular outflow tract (RVOT) gradient increased from 38 ± 22 mmHg at rest to 82 ± 33 mmHg after exercise, but this did not correlate with exercise times. Stress echocardiography is useful in evaluating patients after childhood Ross surgery for aortic valve disease. In this pediatric cohort, most patients achieved normal exercise capacity. The presence of mild or moderate RVOT obstruction had no significant impact on exercise capacity.
authors.affiliation: Department of Pediatric Cardiology, Penn State Hershey Children's Hospital, Hershey, PA 17033, USA. lpauliks@hmc.psu.edu
authors.forename: Linda B
authors.initials: LB
authors.lastname: Pauliks
authors.forename: J
authors.initials: J
authors.lastname: Brian Clark
authors.forename: Ashley
authors.initials: A
authors.lastname: Rogerson
authors.forename: Amy
authors.initials: A
authors.lastname: DiPietro
authors.forename: John L
authors.initials: JL
authors.lastname: Myers
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Cyran
mesh_terms: D000293:Adolescent; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000601:surgery*; D002648:Child; D025401:Echocardiography, Stress; D017079:Exercise Tolerance; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D016014:Linear Models; D008297:Male; D011664:Pulmonary Valve / Q000000981:diagnostic imaging* / Q000601:surgery* / Q000637:transplantation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult