Title: Rest and Exercise Hemodynamics After the Ross Procedure: An Echocardiographic Study
Abstract: Journal of Cardiac SurgeryVolume 13, Issue 3 p. 177-185 Rest and Exercise Hemodynamics After the Ross Procedure: An Echocardiographic Study Francisco Da Costa M.D, Corresponding Author Francisco Da Costa M.D Pontifácia Universidade Católica do Paraná (PUC-Pr) and Santa Casa de Curitiba, Paraná, BrazilRua Henrique Coelho Neto, 55, 82200-120 Curitiba, Parana, Brazil. Fax: 055-41-3240515Search for more papers by this authorHermínio Haggi M.D, Hermínio Haggi M.D Pontifácia Universidade Católica do Paraná (PUC-Pr) and Santa Casa de Curitiba, Paraná, BrazilSearch for more papers by this authorRita Pinton M.D, Rita Pinton M.D Pontifácia Universidade Católica do Paraná (PUC-Pr) and Santa Casa de Curitiba, Paraná, BrazilSearch for more papers by this authorWalmor Lenke M.D, Walmor Lenke M.D Pontifácia Universidade Católica do Paraná (PUC-Pr) and Santa Casa de Curitiba, Paraná, BrazilSearch for more papers by this authorEduardo Adam M.D, Eduardo Adam M.D Pontifácia Universidade Católica do Paraná (PUC-Pr) and Santa Casa de Curitiba, Paraná, BrazilSearch for more papers by this authorIseu S. E. A. Costa M.D, Iseu S. E. A. Costa M.D Pontifácia Universidade Católica do Paraná (PUC-Pr) and Santa Casa de Curitiba, Paraná, BrazilSearch for more papers by this author Francisco Da Costa M.D, Corresponding Author Francisco Da Costa M.D Pontifácia Universidade Católica do Paraná (PUC-Pr) and Santa Casa de Curitiba, Paraná, BrazilRua Henrique Coelho Neto, 55, 82200-120 Curitiba, Parana, Brazil. Fax: 055-41-3240515Search for more papers by this authorHermínio Haggi M.D, Hermínio Haggi M.D Pontifácia Universidade Católica do Paraná (PUC-Pr) and Santa Casa de Curitiba, Paraná, BrazilSearch for more papers by this authorRita Pinton M.D, Rita Pinton M.D Pontifácia Universidade Católica do Paraná (PUC-Pr) and Santa Casa de Curitiba, Paraná, BrazilSearch for more papers by this authorWalmor Lenke M.D, Walmor Lenke M.D Pontifácia Universidade Católica do Paraná (PUC-Pr) and Santa Casa de Curitiba, Paraná, BrazilSearch for more papers by this authorEduardo Adam M.D, Eduardo Adam M.D Pontifácia Universidade Católica do Paraná (PUC-Pr) and Santa Casa de Curitiba, Paraná, BrazilSearch for more papers by this authorIseu S. E. A. Costa M.D, Iseu S. E. A. Costa M.D Pontifácia Universidade Católica do Paraná (PUC-Pr) and Santa Casa de Curitiba, Paraná, BrazilSearch for more papers by this author First published: 09 July 2010 https://doi.org/10.1111/j.1540-8191.1998.tb01258.xCitations: 13AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Abstract Abstract Background: Aortic prosthetic valves with superior hemodynamic performance are associated with more complete regression of left ventricular hypertrophy and better left ventricular function postoperatively. The near normal function of the pulmonary auto grafts at rest is well documented, however, exercise data has been seldom reported. The purpose of this study is to evaluate the hemodynamic performance of pulmonary autografts in the aortic position and the homografts used to reconstruct the right ventricular outflow tract during conditions of high cardiac output by means of dobutamine stress echocardiography. Methods: Between May 1995 and February 1998,67 patients were submitted to a Ross operation at our institution. Twenty of these patients had a mean age of 28.6 ± 8.3 years and a mean follow-up time of 15.7 ± 5.9 months. They were studied by dobutamine stress echocardiography to evaluate rest and exercise hemodynamics of the pulmonary autografts as well as of the aortic and pulmonary homografts used to reconstruct the right ventricular outflow tract. Dobutamine infusion was started at 5 μg/kg with incremental doses up to 40 (μg/kg in every case. Results: With dobutamine infusion, heart rate increased from 71 ± 10 to 142 ±11 beats/min, left ventricular systolic volume from 86.8 ± 33.9 mL to 115.9 ± 52.6 mL, and cardiac output from 6.3 ± 2.9 L/min to 16.8 ± 7.4 L/min. Left ventricular function was considered satisfactory at rest and during exercise in all patients. The mean gradient across the autograft increased from 1.03 ± 0.95 mmHg to 4.03 ± 2.05 mmHg and maximal instantaneous gradient from 2.45 ± 2.21 mmHg to 9.54 ± 4.85 mmHg. The mean effective orifice area for the autografts were 3.5 ± 1.3 cm2 at rest and 3.3 ±1.4 cm2 during exercise. The patients with mild aortic insufficiency at rest had no increase in the degree of regurgitation with exercise. In the right ventricular outflow tract, the mean gradient across the homograft increased from 9.06 ± 5.29 mmHg to 17.55 ± 9.76 mmHg and maximal instantaneous gradient from 21.4 ± 12.5 mmHg to 41.5 ± 23.1 mmHg. Conclusions: Pulmonary autografts exhibit normal hemodynamic performance at rest and during exercise after the Ross operation. However, mild-to-moderate gradients are common at the right ventricular outflow tract and should be carefully monitored. REFERENCES 1 Wang Z., Grainger N., Chambers J.: Doppler echocardiography in normally functioning replacement heart valves: A Literature Review. J Heart Valve Dis 1995; 4: 591– 614. 2 Izzat MB, Birdi I., Wilde P. et al: Comparison of hemodynamic performance of St. Jude Medical and Carbomedics 21 mm aortic prostheses by means of dobutamine stress echocardiography. J Thorac Cardiovas Surg 1996; 11: 408– 415. 3 Izzat MB, Birdi I., Wilde P. et al: Evaluation of the hemodynamic performance of small carbomedics aortic prostheses using dobutamine-stress doppler echocardiography. Ann Thorac Surg 1995: 60: 1048– 1052. 4 Jaffe WM, Coverdale A., Roche AHG et al: Rest and exercise hemodynamic of 20 to 23 mm allograft, Medtronic intact (porcine), and St. Jude Medical valves in the aortic position. J Thorac Cardiovasc Surg 1990; 100: 167– 174. 5 Rahimtoola SH. The problem of valve prosthesis-patient mismatch. Circulation 1978; 58: 20– 24. 6 Wiseth R., Levang OW, Tangen G. et al: Exercise hemodynamic in small (≤ 21 mm) aortic valve prosthesis assessed by Doppler echocardiography. Am Heart J 1993; 125: 138– 145. 7 Zabalgoitia M., Kopec K., Oneschuk L. et al: Use of dobutamine stress echocardiography in assessing mechanical aortic prostheses: Comparison with exercise echocardiography. J Heart Valve Dis 1997; 6: 253– 257. 8 Kadfir I., Izzat MB, Birdi I. et al: Hemodynamic of St. Jude Medical prostheses in the small aortic root: In vivo studies using dobutamine doppler echocardiography. J Heart Valve Dis 1997; 6: 123– 129. 9 Matsuki O., Okita Y., Almeida RS et al: Two decades' experience with aortic valve replacement with pulmonary autograft. J Thorac Cardiovas Surg 1988; 95: 705– 711. 10 David TE, Omran A., Rakowski H. et al: Geometric mismatch of the aortic and pulmonary roots causes aortic insufficiency after the Ross procedure. J Thorac Cardiovasc Surg 1996; 112: 1233– 1239. 11 Daenen W., Gewillig M. Factors influencing medium-term performance of right-sided cryopreserved homografts. J Heart Valve Dis 1997; 6: 349– 354. 12 Ward KE, Elkins RC, Overholt ED et al: Evaluation of cryopreserved homografts in the right ventricular outflow tract after the Ross procedure: Intermediate-term follow up. J Heart Valve Dis 1997; 6: 130– 133. 13 Rizzo DF, Goldmann BS, David TE: Hemodynamic benefits of the Toronto Stentless Valve. J Thorac Cardiovasc Surg 1996; 112: 1431– 1446. 14 Jin XY, Gibson DG, Yacoub MH et al: Perioperative assessment of aortic homograft, toronto stentless valve, and stented valve in the aortic position. Ann Thorac Surg 1995; 2(Suppl); S395– S401. 15 Elkins RC, Santangelo K., Stelzer P. et al: Pulmonary autograft replacement of the aortic valve: An evolution of technique. J Card Surg 1992; 7: 108– 116. 16 Feigenbaum H.: Echocardiography. In E. Braunwald (ed): Heart Disease 5 th ed. WB Saunders, Phildelphia, 1997, pp. 53– 107. 17 Kouchoukos NT, Davila-Roman VG, Spray TL et al: Replacement of the aortic root with a pulmonary autograft in children and young adults with aortic-valve disease. N Engl J Med 1994; 330: 1– 6. 18 Oury JH, Doty D., Oswalt JO et al: Cardiopulmonary response to maximal exercise in young athletes following the Ross procedure. VII International Symposium Cardiac Bioprostheses. Abstract of the VII International Symposium Cardiac Bioprostheses. Barcelona, 1997s. 19 Eriksson MJ, Brodin L., Dellgren GN et al: Rest and exercise hemodynamics of an extended stentless aortic bioprosthesis. J Heart Valve Dis 1997; 6: 653– 665. 20 Brux J., Subayi J., Binuani P. et al: Doppler-echocardiographic assessment of the carbomedics supra-annular Top-Hat' prosthetic heart valve in the aortic position. J Heart Valve Dis 1996; 5: 336– 338. 21 Hasegawa J., Kitamura S., Taniguchi S. et al: Comparative rest and exercise hemodynamic of altograft and prosthetic valves in the aortic position. Ann Thorac Surg 1997; 64: 1753– 1756. 22 Gray RJ, Chaux A., Matloff JM et al: Bileaflet, tilting disc and porcine aortic valve substitutes: In vivo hydrodynamic characteristics. J Am College Cardiol 1984; 3: 321– 327. 23 Costa FDA, Pinton R., Haggi Filho H. et al: Operagao de Ross: An intervencao ideal para pacientes jovens? Rev Bras Cir Cardiovasc 1996; 99– 109. 24 Saravalli OA, Somerville J., Jefferson KE: Calcification of aortic homografts used for reconstruction of the right ventricular outflow tract. J Thorac Cardiovasc Surg 1980; 80: 909– 920. 25 Bando K., Danielson GK, Schaff HV et al: Outcome of pulmonary and aortic homograft for right ventricular outflow reconstruction. J Thorac Cardiovasc Surg 1995; 109: 509– 518. 26 Sardari F., Gundry SR, Razzouk AJ et al: The use of larger size pulmonary homografts for the Ross operation in children. J Heart Valve Dis 1996; 5: 410– 413. Citing Literature Volume13, Issue3May 1998Pages 177-185 ReferencesRelatedInformation