Children and Young Adults after Ross and Ross-Konno Operation Have Impaired Ventricular Septal Function Associated with Aortic Stiffness
Michal Schäfer, Lorna Browne, MD, Max Mitchell, MD, David Campbell, MD, James Jaggers, MD.
University of Colorado - Children's Hospital Colorado, Aurora, CO, USA.
Objective(s): The Ross/Ross Konno procedures are considered successful for treating critical aortic stenosis but the resultant left ventricular (LV) septal dysfunction and altered aortic compliance may adversely affect LV-aortic coupling. Our aim was to assess LV mechanics and aortic stiffness after both procedures using MRI techniques compared with healthy controls.
Methods: Patients who underwent prior Ross (n=10) and Ross-Konno (n=10) were compared with controls (n=10) for longitudinal and circumferential strain (LS and CS), mechanical dyssynchrony and aortic pulse wave velocity (PWV).
Results: Compared to controls, Ross group had decreased LV-LS (13 vs. 16 %, P = 0.039), septal CS (12 vs. 17 %, P = 0.017), elevated septal dyssynchrony (83 vs. 43 ms, P = 0.004), and increased aortic-PWV (2.8 vs. 2.0 m/s, P = 0.010). Ross-Konno patients presented even more reduced LV-LS (11 vs. 16 %, P = 0.011), septal CS (11 vs. 17%, P = 0.008), and septal dyssynchrony (96 vs. 43 ms, P < 0.001) and increase in aortic-PWV which was significantly larger than both control (3.7 vs. 2.0 m/s, P < 0.001) and Ross groups (3.7 vs. 2.8 m/s, P = 0.016). Aortic-PWV in all groups had strong negative correlation with LV-LS (R = -0.71, P = 0.003) suggesting negative LV-aortic interactions.
Conclusions: Increased aortic stiffness and septal dysfunction appear to be interrelated and are present longterm after both Ross and Ross Konno (worse after Ross-Konno). The cycle of worsening stiffness potentiating further LV dysfunction may result in chronic LV systemic afterload elevation long after repair.
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