Hörer Jürgen, Kasnar-Samprec Jelena, Charitos Efstratios, Stierle Ulrich, Bogers Ad J J C, Hemmer Wolfgang, Hetzer Roland, Hübler Michael, Robinson Derek R, Sievers Hans H, Lange Rüdiger
Department of Cardiovascular Surgery, German Heart Center Munich at the Technische Universität München, Munich, Germany.
World J Pediatr Congenit Heart Surg. 2013 Jul;4(3):245-52. doi: 10.1177/2150135113485763.
The Ross operation provides the advantage of growth potential of the pulmonary autograft in the aortic position. However, development of autograft dilatation and regurgitation may occur. We sought to assess the progression of autograft diameters and aortic regurgitation (AR) with regard to patient age at the time of the Ross operation.
Autograft echo dimensions from 48 children <16 years of age at the time of the Ross operation, who had follow-up echocardiograms at <20 years of age, were analyzed using hierarchical multilevel modeling. The z values of autograft dimensions were calculated according to the normal aortic dimensions. Mean follow-up was 5.1 ± 3.3 years. The mean age at the time of the Ross operation was 10.0 ± 4.3 years.
The mean z values of all patients showed a significant increase with follow-up time at the sinus (0.5 ± 0.1/year, P < .001) and the sinotubular junction (0.7 ± 0.2/year, P < .001) but not at the annulus (0.1 ± 0.1/year, P = .59). There was no significant difference in the z values of sinus and the sinotubular junction between younger and older children at implantation and with time. The initial annulus z value was significantly larger in younger children (P < .0001), whereas the annual increase was significantly higher in older children (P = .021). Age at operation has no impact on the initial AR grade (P = .60). The AR tends to increase more quickly in older patients (P = .040). Sinus and sinotubular junction dilate with time, regardless of patient age.
Young children show larger initial annulus sizes than older children. However, annulus diameters tend to normalize in young children, whereas they increase in older children. Autograft regurgitation develops slowly, but significantly, and predominantly in older children. Stabilizing measures to prevent autograft root dilatation are warranted in adolescents, but they are not required in young children.
罗斯手术具有肺动脉自体移植物在主动脉位置生长潜力的优势。然而，可能会出现自体移植物扩张和反流的情况。我们试图评估罗斯手术时患者年龄与自体移植物直径及主动脉反流（AR）进展之间的关系。
对48例罗斯手术时年龄小于16岁且在20岁之前进行了超声心动图随访的儿童的自体移植物回声尺寸进行分层多级建模分析。根据正常主动脉尺寸计算自体移植物尺寸的z值。平均随访时间为5.1±3.3年。罗斯手术时的平均年龄为10.0±4.3岁。
所有患者的平均z值在随访期间在窦部（0.5±0.1/年，P<.001）和窦管交界部（0.7±0.2/年，P<.001）均有显著增加，但在瓣环处（0.1±0.1/年，P=.59）无显著增加。植入时及随访期间，年龄较小和较大的儿童在窦部和窦管交界部的z值无显著差异。年龄较小的儿童初始瓣环z值显著更大（P<.0001），而年龄较大的儿童每年的增加更为显著（P=.021）。手术年龄对初始AR分级无影响（P=.60）。AR在年龄较大的患者中往往增加得更快（P=.040）。无论患者年龄如何，窦部和窦管交界部都会随时间扩张。
年龄较小的儿童初始瓣环尺寸比年龄较大的儿童大。然而，年龄较小的儿童瓣环直径趋于正常化，而年龄较大的儿童则会增加。自体移植物反流发展缓慢，但显著，且主要发生在年龄较大的儿童中。青少年有必要采取稳定措施以防止自体移植物根部扩张，但年龄较小的儿童则不需要。
