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Regression of left ventricular hypertrophy in children following the Ross procedure
Juan Lehoux1, Michael F Swartz, Nader Atallah-Yunes
1Department of Surgery, University of Rochester Medical Center, Strong Memorial Hospital, Rochester, NY, USA.
Insights
The Ross procedure effectively reverses left ventricular hypertrophy (LVH) in children with aortic valve disease. Most children showed significant LVH regression after surgery, with sustained improvement over time.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Cardiovascular Physiology
Background:
- Left ventricular hypertrophy (LVH) is a common complication in pediatric aortic valve disease.
- The extent of LVH regression after surgical intervention, specifically the Ross procedure, requires further elucidation.
Purpose of the Study:
- To evaluate the effectiveness of the Ross procedure in regressing left ventricular hypertrophy (LVH) in pediatric patients.
- To assess the long-term changes in left ventricular mass index (LVMI) and z scores post-Ross procedure.
Main Methods:
- A cohort of pediatric patients (<18 years) undergoing the Ross procedure was analyzed.
- Left ventricular mass index (LVMI) and z scores were calculated and tracked over time.
- LVH was defined as LVMI > 39 g/m(2.7) or z score >1.6.
Main Results:
- Ninety-six percent (24/25) of children demonstrated LVMI regression from baseline.
- Mean LVMI decreased significantly from 70.8 ± 31.2 to 41.8 ± 16.6 g/m(2.7) (P < 0.001).
- LVMI z scores also decreased significantly from 2.2 ± 1.2 to 0.2 ± 1.9 (P < 0.001), with sustained decline over 10 years.
Conclusions:
- The Ross procedure is highly effective in reversing left ventricular hypertrophy in children with aortic valve disease.
- Significant and sustained regression of LVH is observed following the Ross procedure, indicating its therapeutic benefit.
Objectives:
Left ventricular hypertrophy (LVH) frequently accompanies the progression of aortic valve disease in children. The extent of LVH regression following surgical relief of aortic valve disease in children has not been clearly elucidated. We hypothesized that significant regression of LVH will occur in children following the Ross procedure.
Methods:
We examined LVH over time in children <18 years of age who underwent the Ross procedure. Left ventricular mass index (LVMI) and corresponding z scores were calculated based on height, age and gender. Left ventricular hypertrophy was defined as an LVMI of > 39 g/m(2.7) and a z score of >1.6.
Results:
Twenty-five children underwent the Ross procedure. The left ventricular mass increased proportionally with the growth of the child from baseline to the latest follow-up at 7.3 ± 2.9 years (121.1 ± 81.5 vs 133.1 ± 79.8 g, P = 0.4). However, 96% (24/25) of children demonstrated LVMI regression from baseline. Mean LVMI decreased from 70.8 ± 31.2 to 41.8 ± 16.6 g/m(2.7) (P < 0.001). Similarly, LVMI z scores decreased from 2.2 ± 1.2 to 0.2 ± 1.9 (P < 0.001). Freedom from LVH was 83% at 10 years. Examination of LVMI and z scores over time demonstrated that the largest decrease occurred after the first year, with continued gradual decline over 10 years of follow-up.
Conclusions:
The Ross procedure is effective in reversing LVH in children with aortic valve disease.
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