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J Thorac Cardiovasc Surg 2000;119:4-009
© 2000 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

INCREASE IN SIZE OF THE PULMONARY AUTOGRAFT AFTER THE ROSS OPERATION IN CHILDREN: GROWTH OR DILATION?

From the Section of Paediatric Cardiology, Department of Paediatrics and Department of Thoracic Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.

Supported by a grant from the Gothenburg Medical Society.

Address for reprints: Laszlo Solymar, MD, PhD, Section of Paediatric Cardiology, Department of Paediatrics, Sahlgrenska University Hospital, S-416 85, Göteborg, Sweden (E-mail: laszlo.solymar{at}sahlgrenska.se).

Objective: We sought to assess growth properties of the pulmonary autograft after the Ross operation in children.
Methods: Eight infants with critical aortic stenosis who underwent the Ross operation early in life (median age, 6.4 months) were followed up regarding the possible growth of the autograft. The pulmonary autograft was measured repeatedly by echocardiography during the follow-up, ranging from 6 months to 7 years (median, 5.2 years). Twelve normal children who served as control subjects were similarly followed from 3.9 to 5.8 years (median, 4.9 years).
Results: Somatic growth during the follow-up period was significant and was reflected in a doubling of the body surface area, which increased from 0.33 ± 0.14 m² to 0.74 ± 0.21 m². The proximal part of the autograft increased from 13.6 ± 3.6 mm to 23.3 ± 3.7 mm (mean ± SD) and the distal part from 10.5 ± 2.5 mm to 15.9 ± 2.8 mm. Growth pattern of the autograft was analyzed by relating measured diameters to predicted normal diameters (ie, Z values). During the first year after the operation, the mean Z value of the proximal autograft increased from 0.2 to 2.2, indicating a more rapid increase than the predicted increase and was also significantly higher than that of the control group (P = .01). After the first year, Z-value changes in patients and control subjects were very similar.
Conclusions: We thus conclude that the pulmonary autograft in the aortic position after the Ross operation does increase in size and that the pattern of this increase is suggestive of passive dilation in the early postoperative period, followed by normal active growth.

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