Left Ventricular Remodeling After Pulmonary Autograft Aortic Valve Replacement: Evaluation with Color‐Doppler Echocardiography and Magnetic Resonance Imaging

Abstract

The superior hemodynamic performance of the pulmonary autograft in aortic position is expected to reflect complete regression of hypertrophy and improved ventricular function. We evaluated and compared early and midterm transthoracic color-Doppler echocardiography (TTE) and magnetic resonance imaging (MRI) assessment concerning left ventricular (LV) function, LV mass regression, and performance of the semilunar valves. A total of 42 consecutive patients, mean age 36 +/- 6 years (range 15 to 56 years), were studied. TTE and MRI were performed preoperatively, at discharge, and at 6 and 12 months postoperatively. Left ventricular diameters and function and LV wall thickness and mass were assessed. There was no early and one late postoperative death. Maximum and mean LV outflow gradients were significantly reduced (p = 0.0001 and p = 0.0001, respectively). There was a significant reduction in left ventricular mass to near normal for all patients (p = 0.001) seen after 6 months. This was paralleled by significant reductions in the interventricular septum and posterior wall thickness, but difference was slight during further follow-up. There was a strong correlation between the results obtained by TTE and MRI for LV mass and ejection fraction (r = 0.86 and 0. 87, respectively). The pulmonary autograft operation gives excellent results that are translated into greater, rapid, and near complete regression of LV hypertrophy. Magnetic resonance imaging is a sensitive and noninvasive methodology that provides reliable visualization and quantification of ventricular performance.

Die Entwicklung der Durchmesser des pulmonalen Autografts und linken Ventrikels nach Ross-Operation bei Kindern und Jugendlichen

“…Ebenso kam es in diesem Zeitraum zu einer signifikanten Abnahme der Durchmesser sowohl des IVS als auch der HW des linken Ventrikels. Auch der LVEDD nahm ab, jedoch ohne statistisch nachweisbare Signifikanz(Schmid et al 2002). Im Jahre 2005 veröffentlichten Duebener et al Daten aus dem Deutschen Ross-Register von Patienten mit einem Durchschnittsalter von 43,6 Jahren (insgesamt 646 jugendliche und erwachsene Patienten im Alter von 16 bis 71 Jahre).…”