Pauliks Linda B, Brian Clark J, Rogerson Ashley, DiPietro Amy, Myers John L, Cyran Stephen E
Department of Pediatric Cardiology, Penn State Hershey Children's Hospital, Hershey, PA 17033, USA.
Pediatr Cardiol. 2012 Jun;33(5):797-801. doi: 10.1007/s00246-012-0218-7. Epub 2012 Feb 21.
Adult studies suggest a better functional outcome after aortic valve replacement with a pulmonary autograft compared with mechanical or homograft valves. Little is known about functional results after Ross surgery in growing children. This study reports formal exercise stress echocardiographic data from 26 pediatric Ross patients. A retrospective cohort study analyzed stress echocardiographic data of patients who underwent Ross surgery as a child (<17 years old). All patients were operated by a single surgeon and underwent a Bruce protocol stress echocardiogram on the treadmill. Twenty-six patients (4 girls) were 9.3 ± 5.0 years at surgery and 14.9 ± 3.5 years (range 6.6-19.7 years) at follow-up. Mean follow-up was 5.4 ± 3.7 years (median 4.2). All were asymptomatic. The exercise time was normal in 87% of cases at 12.8 ± 2.5 min. On stress echocardiography, the mean right-ventricular outflow tract (RVOT) gradient increased from 38 ± 22 mmHg at rest to 82 ± 33 mmHg after exercise, but this did not correlate with exercise times. Stress echocardiography is useful in evaluating patients after childhood Ross surgery for aortic valve disease. In this pediatric cohort, most patients achieved normal exercise capacity. The presence of mild or moderate RVOT obstruction had no significant impact on exercise capacity.
成人研究表明，与机械瓣膜或同种异体瓣膜相比，采用自体肺动脉瓣膜进行主动脉瓣置换术后功能结局更佳。对于成长中的儿童接受罗斯手术（Ross手术）后的功能结果，人们了解甚少。本研究报告了26例接受罗斯手术的儿科患者的正式运动负荷超声心动图数据。一项回顾性队列研究分析了儿童期（<17岁）接受罗斯手术患者的负荷超声心动图数据。所有患者均由同一外科医生进行手术，并在跑步机上接受了布鲁斯方案运动负荷超声心动图检查。26例患者（4名女孩）手术时年龄为9.3±5.0岁，随访时年龄为14.9±3.5岁（范围6.6 - 19.7岁）。平均随访时间为5.4±3.7年（中位数4.2年）。所有患者均无症状。87%的病例运动时间正常，为12.8±2.5分钟。在负荷超声心动图检查中，右心室流出道（RVOT）平均压力阶差从静息时的38±22 mmHg增加至运动后的82±33 mmHg，但这与运动时间无关。运动负荷超声心动图对于评估儿童期因主动脉瓣疾病接受罗斯手术后的患者很有用。在这个儿科队列中，大多数患者达到了正常的运动能力。轻度或中度RVOT梗阻的存在对运动能力没有显著影响。
