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Neo-aortic Root Dilatation, Aortic Stiffness, and Ventricular interactions in Long-Term Follow-Up After the Ross Procedure in Childhood

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Abstract

Patients after the Ross procedure are at risk for right (RV) and left ventricular (LV) dysfunction due to neo-aortic and pulmonary dysfunction. While neo-aortic root dilatation has been related to LV dysfunction, the potential contributions of aortic stiffness and ventricular interactions have not been evaluated. Patients status post Ross procedure up to age 18 years with cardiac magnetic resonance (CMR) exam from 2007 to 2018 were retrospectively reviewed. Aortic pulse wave velocity (PWV) was calculated from phase contrast and angiogram images. RV and LV peak global longitudinal (GLS) and circumferential strain (GCS) were measured using tissue tracking software. Multivariable regression was performed for variables associated with parameters of LV function. In 58 patients (median age 20.5 years at CMR exam), male gender, longer time since Ross procedure, aortic root dilatation, and lower RV ejection fraction (EF) were associated with decreased LV EF. There was no association with LV late gadolinium enhancement or neo-aortic or conduit regurgitation. LV GCS and GLS also correlated with RV GCS, RV GLS and PWV. In multivariable analysis, the relation of RV and LV systolic function, but not aortic measurements, remained significant. In conclusion, in long-term follow-up after pediatric Ross procedure, RV function rather than aortic root size or aortic stiffness most closely relates to LV function. Ventricular interactions may impact decision-making on timing of conduit intervention, which could differ from established criteria in populations with only aortic or pulmonary valve disease. Further study is warranted to evaluate possible association with clinical outcome.

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Acknowledgements

We would like to thank the University of Michigan Congenital Heart Outcomes Research and Discovery program (MCHORD) for their work and assistance in this study.

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX, USA

    Mehul D. Patel

  2. Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA

    Adam L. Dorfman, Sunkyung Yu, Ray Lowery & Jimmy C. Lu

  3. Section of Pediatric Radiology, Department of Radiology, University of Michigan, Ann Arbor, MI, USA

    Adam L. Dorfman, Maryam Ghadimi Mahani & Jimmy C. Lu

  4. Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, MI, USA

    Maryam Ghadimi Mahani & Prachi P. Agarwal

  5. Division of Pediatric Cardiology, Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA

    Jason T. Christensen

  6. UT Physicians Pediatric Cardiology, 6410 Fannin St, UT Professional Building Suite 425, Houston, TX, 77030, USA

    Mehul D. Patel

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  1. Mehul D. Patel
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Correspondence to Mehul D. Patel.

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This article does not contain any studies with human participants or animals performed by any of the authors. This study was approved by the University of Michigan Institutional Review Board and Human Research Protection Program.

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Patel, M.D., Dorfman, A.L., Yu, S. et al. Neo-aortic Root Dilatation, Aortic Stiffness, and Ventricular interactions in Long-Term Follow-Up After the Ross Procedure in Childhood. Pediatr Cardiol 41, 1107–1114 (2020). https://doi.org/10.1007/s00246-020-02360-9

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  • DOI: https://doi.org/10.1007/s00246-020-02360-9

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