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Left Ventricular Dysfunction And Electromechanical Discoordination Following The Ross-konno Operation Are Independent Of The Surgical Reconstruction
Matthew Stone, MD, PhD, Michal Schafer, PhD, Johannes C. von Alvensleben, MD, Benjamin S. Frank, MD, David N. Campbell, MD, Max B. Mitchell, MD, James Jaggers, MD.
University of Colorado School of Medicine, Aurora, CO, USA.

Objective: The Ross-Konno (RK) operation is a well-established surgical treatment for combined left ventricular outflow tract obstruction and aortic valve pathology in children. Prior study has demonstrated that mechanical and electrical dyssynchrony exist post-RK compared to normal controls. The purpose of this study was to evaluate myocardial electromechanical function pre- and post-RK as defined by echocardiography. Methods: Patients undergoing the RK operation (n=13; median age: 1.3 years; range: 0.5-13.3 years) were evaluated by echocardiography at defined timepoints: pre-RK, post-RK, 1-year post-RK, and 2 years post-RK. Defined parameters of left ventricular performance were analyzed: systolic mechanical dyssynchrony (M-Dys), global left ventricular circumferential strain (GCS), diastolic relaxation fraction (DRF), and electro-mechanical discoordination. Patients with post-operative atrioventricular block (n=6) were analyzed separately. Results: As demonstrated in Figure 1, no pre- versus post-RK differences existed in M-Dys, GCS, or DRF in patients both with and without post-RK atrioventricular block. Further, 1- and 2-year follow-up post-RK demonstrated significant heterogeneity in evaluated parameters of function with no pre- and post-RK differences in M-Dys, GCS, or DRF.Conclusion: Mechanical and electrical dyssynchrony exist post-RK reconstruction in both short- and long-term follow-up yet these echocardiographic parameters of ventricular performance are independent of the RK operation. Further study is, therefore, warranted to define causal relationships for observed short- and long-term ventricular dysfunction post-RK and suggest a deleterious mechanism apart from the technical RK reconstruction.


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