Exercise Stress Echocardiography After Childhood Ross Surgery: Functional Outcome in 26 Patients From a Single Institution

Abstract

Adult studies suggest a better functional outcome after aortic valve replacement with a pulmonary autograft compared with mechanical or homograft valves. Little is known about functional results after Ross surgery in growing children. This study reports formal exercise stress echocardiographic data from 26 pediatric Ross patients. A retrospective cohort study analyzed stress echocardiographic data of patients who underwent Ross surgery as a child (<17 years old). All patients were operated by a single surgeon and underwent a Bruce protocol stress echocardiogram on the treadmill. Twenty-six patients (4 girls) were 9.3 ± 5.0 years at surgery and 14.9 ± 3.5 years (range 6.6-19.7 years) at follow-up. Mean follow-up was 5.4 ± 3.7 years (median 4.2). All were asymptomatic. The exercise time was normal in 87% of cases at 12.8 ± 2.5 min. On stress echocardiography, the mean right-ventricular outflow tract (RVOT) gradient increased from 38 ± 22 mmHg at rest to 82 ± 33 mmHg after exercise, but this did not correlate with exercise times. Stress echocardiography is useful in evaluating patients after childhood Ross surgery for aortic valve disease. In this pediatric cohort, most patients achieved normal exercise capacity. The presence of mild or moderate RVOT obstruction had no significant impact on exercise capacity.

Semi-supine Exercise Stress Echocardiography in Children and Adolescents: Feasibility and Safety

“…The wide heterogeneity in terms of the studied cohort and indications for testing is testified by the presence of isolated reports on use of stress echocardiography in children in completely different clinical settings. There are few reports focused on assessing the presence of CAD after heart transplantation [ 12 , 15 , 16 , 28 , 30 , 46 ] or after arterial switch operation in patients born with transposition of the great arteries [ 19 , 23 ] or in subjects with history of Kawasaki disease [ 20 , 24 , 34 , 47 ], as well as studies providing dynamic evaluation in patients with congenital left heart disease [ 1 , 5 , 14 , 35 ], repaired tetralogy of Fallot [ 3 , 10 ], repaired complex congenital heart defects [ 19 , 26 , 38 ], and after Fontan operation [ 9 ].…”

Predictors of Left Ventricular Remodeling after Aortic Valve Replacement in Pediatric Patients with Isolated Aortic Regurgitation

“…Stress echocardiography has been shown to be useful in evaluating pediatric patients after childhood Ross surgery for aortic valve disease . There is a role for probably using stress echocardiography in detecting the persistent LV remodelling/dysfunction at follow‐up after surgery in further studies.…”