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Comparison of some morphometric and functional parameters for both ventricles and great vessel valves in children (below 7 years of age and older) who underwent Ross procedure for congenital complex aortic valve disease

Background:
Aortic valve replacement with pulmonary autograft was first performed in 1967 by D. Ross in Guy’s Hospital in London. Ross operation’s advantages over other forms of aortic valve replacement are optimal haemodynamic pattern of blood flow and autograft growth potential.

Material and methods:
From 1995 to 2002 45 pts underwent Ross operation at the Cardiosurgery Department of the Polish Memorial Hospital – Research Institute in Łódź. Age of patients ranged from 0.5 yr to 22 yrs (mean 12.26±6.43 yr). Follow-up was from 1 yr to 7 yrs (mean 2.49±1.65 yr). Combined aortic valve disease (AS+AI) was revealed in 30 pts and all patients were divided into 2 groups: 7 years old or below, and over 7 yrs of age. Transthoracic echocardiographic examination (M-mode and 2-D technique) was basic and obligatory to assess the results of the operation in this paper. Echocardiographic assessment was performed prior to Ross procedure and 1 week, 1 year and 2-5 yrs after the operation.

Results:
Morphometric and functional parameters of both ventricles and great vessel valves were assessed based on ECHO exams. RVEDD diameter was statistically higher and exceeded normal values in older children, although it was in the normal range before operation. Statistically significant relations of compared parameters were obtained in both groups in all follow-up periods.

Conclusions:
Ross operation improved clinical status of patients at any time of life, but 1 yr after operation normalization of IVS thickness and LVPWD diameter was achieved in 50% of patients under 7 yrs of age. In older children normalization of these parameters became slower. LVEDD was normalized in all older children and only in half of younger ones at mid-term follow-up. Problems concerning RV enlargement in patients after Ross operation are going to be analyzed to explain this phenomenon.