Right Ventricle Function in Patients after Ross Operation: Short-, Mid- and Long-Term Echocardiographic Follow-ups

  • Dr Andrii Kurkevych, Ukrainian Children's Cardiac Center, Kyiv, Ukraine, Ukraine
  • Dr Oleksandr Romanyuk, Ukrainian Children's Cardiac Center, Kyiv, Ukraine, Ukraine
  • Dr Valentyna Khanenova, Ukrainian Children's Cardiac Center, Kyiv, Ukraine, Ukraine
  • Dr Ihor Lebid', Crimea State Medical University, Simferopol, Ukraine
  • Dr Nadia Rudenko, Ukrainian Children's Cardiac Center, Kyiv, Ukraine, Ukraine
  • Dr Illya Yemets, Ukrainian Children's Cardiac Center, Kyiv, Ukraine, Ukraine

    • Objective. To assess the right ventricle (RV) function by echocardiography in early, middle and late period after Ross operation (RO).
    Material and Methods. We studied 52 patients after RO: group 1 (n=19, aged 10,8±6,4), group 2 (n=19, aged 13,9±5,2), and group 3 (n=13, aged 19,1±5,7), with mean follow-up time: 5,8±2,6; 31,1±11,9; and 82,3±23,0 months, respectively; plus 15 healthy individuals (control group, aged 15,3±7,9). RV function was assessed quantitatively by: 1) ejection fraction (RVEF) and indexed RV end-diastolic volume (RVEDVi), 2) RV myocardial tissue velocities (systolic Sa, early-diastolic Ea, and late-diastolic Aa) and Tei Index, obtained by Tissue Doppler Imaging (TDI) method.
    Results. The longer period after RO, the more RV dilation occurs (RVEDVi from 84,2±15,9 ml/m2 in group 1 to 93,5±18,1 ml/m2 in group 3), with a significant increase compared to control group (74,1±20,3 ml/m2) during mid- and long-term follow-ups (p=0.003 and p=0.014, respectively). Compared to RVEF in control group (58,6±9,3%), RVEF was significantly lower in groups 1-3 (44,5±8,6%, p=0.0001; 45,9±9,8%, p=0.0005; and 46,5±11,4%, p=0.005, respectively), but without tendency to decrease with time. Same pattern was observed with TDI parameters. The global RV function, assessed by Tei Index, was significantly decreased early after RO (0,54±0,08 vs. 0,41±0,04 in control group, p<0.001), with progressive decrease in long-term period (0,64±0,11, p<0.001).
    Conclusions. By quantitative echocardiographic assessment (RVEF, RVEDVi and TDI velocities), we identified slight early postoperative RV systolic and diastolic dysfunction with no negative progression with time. Tei index could be the most sensitive marker for RV function monitoring after RO.