Congenital heart diseaseSimilarities and Differences of the Aortic Root After Arterial Switch and Ross Operation in Children
Section snippets
Methods
The patients were selected through a review of the institutional pediatric cardiology and echocardiography database of the Pediatric Heart Center (Vienna, Austria). The inclusion criteria were age ≤18 years in both patient subgroups. Only isolated complete TGA corrected by single-stage ASO, including the Lecompte maneuver, with only additional ventricular septal defects and/or coarctations of the aorta, were accepted. Of the Ross patients, only those who had undergone the full root replacement
Results
The demographic data are listed in Table 1. As expected from the male predominance in TGA and congenital aortic valve diseases, statistically meaningful differences for this value were found. Significantly larger diameters and greater z scores were found in AV, AoR, STJ, and ascending aorta in patients after ASO than in the control subjects. Similarly, the elastic properties of the aortic root showed significantly stiffer and less distensible values in patients with TGA. Regarding the diameters
Discussion
We were able to show an obvious increase in the neoaortic dimensions and stiffness, together with a remarkable decrease in distensibility of the neoaortic root, in both patient populations compared to healthy children and adolescents. This disproportional increase in dimensions started in the first year after surgery and was neither accompanied, nor provoked, by aortic regurgitation. Despite the shorter time of pressure load to the pulmonary valve in the systemic circulation in the Ross
References (21)
- et al.
Aortic valve regurgitation after arterial switch operation for transposition of the great arteries: incidence, risk factors, and outcome
J Am Coll Cardiol
(2006) - et al.
Neoaortic root diameters and aortic regurgitation in children after the Ross operation
Ann Thorac Surg
(2009) - et al.
Dilation of the pulmonary autograft after the Ross procedure
J Thorac Cardiovasc Surg
(2000) - et al.
Increase in size of the pulmonary autograft after the Ross operation in children: growth or dilation?
J Thorac Cardiovasc Surg
(2000) - et al.
The Ross operation in children: 10-years experience
Ann Thorac Surg
(1998) - et al.
Dissection of a dilated autograft root
J Thorac Cardiovasc Surg
(2007) - et al.
Two-dimensional echocardiographic aortic root dimensions in normal children and adults
Am J Cardiol
(1989) - et al.
Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography
J Am Soc Echocardiogr
(2003) - et al.
Pulmonary artery remodeling in transposition of the great arteries: relevance for neoaortic root dilation
J Thorac Cardiovasc Surg
(2003) - et al.
The outflow tract in transposition of the great arteries: an anatomic and morphologic study
Ann Thorac Surg
(2009)
Cited by (9)
Time course and predictors for neoaortic root dilatation and neoaortic valve regurgitation during adult life after arterial switch operation
2021, Revista Espanola de CardiologiaLong-term survival and reintervention after the Ross procedure across the pediatric age spectrum
2015, Annals of Thoracic SurgeryA modification of the pulmonary autograft procedure to prevent late autograft dilatation
2014, Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery AnnualCitation Excerpt :Finally, there has been increasing concern about the incidence of aortic dilation that occurs late, and eventually in most patients who receive the pulmonary autograft procedure.3,9,18–22 The consequence of neo aorta dilation has been described following arterial switch (which provides an analogous situation to the pulmonary autograft in that the main pulmonary artery becomes the neo aorta) and it is no surprise that it also is described following a pulmonary autograft aortic root replacement.23,24 Despite the attractive long-term benefits of providing a patient with a hemodynamically normal aortic valve that does not require anticoagulation, the risk of autograft dilation that may necessitate root replacement (with or without valve sparing techniques) has created caution in recommending the autograft for adult patients.10
Size and Stiffness of the Pulmonary Autograft after the Ross Procedure in Children
2019, Pediatric CardiologyLong-term outcomes of the arterial switch operation for transposition of the great arteries and ventricular septal defect and/or aortic arch obstruction
2016, Interactive Cardiovascular and Thoracic SurgeryDilatation and Dysfunction of the Neo-aortic Root and in 76 Patients After the Ross Procedure
2016, Pediatric Cardiology