Neo-aortic annular and aortic root dilatation after the ross procedure performed in children and adolescents

The growth potential of the native pulmonary valve/root in the aortic position is an attractive feature of the Ross procedure. We have noted a disproportionate increase in aortic root size in some of our patients after the Ross procedure, hi order to establish changes in neo-aonic valve and root (measured at the aortic sinuses of Valsalva), serial echocardiographic measurements were compared to preoperative values. Follow-up echocardiographic data were analyzed from 21 patients who had the Ross procedure at 3 to 31 years of age (median 16.5 yrs), obtained from 0.1 to 33 months after surgery. AV ring / BSA^0.5 (cm / m²) Ao root / BSA^0.5 (cm / m²) LVED / BSA (cm / m²) At surgery (n=21) 171 ± 0.24 1 2-51 ± 0.41 371 ± 1.36 Up to 1 mo. after surgery (n = 22) 1.84 ± 0.36 2.72 ± 0.34 3.14 ± 0.96 >1-12 mos (n=18) 1.86 ± 0.34 2.87 ± 0.33**3.35 ± 0.71 > 12 moos (n = 7) 1.93 ± 0.30 2.93 ± 0.27*3.17 ± 0.39 1 represents native pulmonary valve: Ao root measured at the sinuses of Valsalva;*p < 0.05,**p < 0.01 compared to preoperative values The changes in aortic dimensions in relation to somatic growth in these patients vs. previously established data in normal controls were as follows: valve annulus 16 vs. 18 mm/ BSA^0.5 and for the aortic root 28 vs. 21 mm/ BSA^0.5. Conclusion: Neo-aortic root dilatation within the first postoperative year suggests an immediate compensatory response of native pulmonary tissue to the systemic circulation. Long-term geometrical changes and hemodynamic implications of these changes will need to be addressed.