Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver Anschutz Medical Campus, Aurora, Colo.
Department of Radiology, Children's Hospital Colorado, University of Colorado Denver Anschutz Medical Campus, Aurora, Colo.
J Thorac Cardiovasc Surg. 2019 Aug;158(2):509-517. doi: 10.1016/j.jtcvs.2019.02.057. Epub 2019 Feb 27.
Ross and Ross-Konno operations are associated with the inherent risk of residual ventricular septal dysfunction and injury to the conduction system. However, comprehensive biventricular functional outcomes on magnetic resonance imaging after Ross and Ross-Konno procedures are unknown. The purpose of this study was to evaluate and compare the degree of electrical and mechanical dyssynchrony using cardiac magnetic resonance imaging in patients late after Ross and Ross-Konno operations.
Patients following Ross operation (n = 16), Ross-Konno operation (n = 13), and healthy controls (n = 12) underwent cardiac magnetic resonance imaging strain deformation analysis to quantify left ventricular (LV) intraventricular dyssynchrony and right ventricular (RV)-LV interventricular dyssynchrony. Mechanical dyssynchrony indices were correlated with the degree of electrical dyssynchrony as assessed by QRS duration, as well as with magnetic resonance imaging-derived biventricular and autograft regurgitation parameters.
Patients in the Ross and Ross-Konno groups had reduced LV global longitudinal strain when compared with controls (both P values < .01). Both Ross (P < .05) and Ross-Konno (P < .01) groups demonstrated increased RV-LV interventricular dyssynchrony compared with controls. Patients in the Ross-Konno group also had increased septal LV intraventricular dyssynchrony when compared with control and Ross groups (both P values < .01). The global LV intramechanical dyssynchrony strongly correlated with QRS duration (R = 0.716; P < .001). There was no association between mechanical dyssynchrony and aortic regurgitation fraction.
Long-term follow-up of patients who underwent Ross and Ross-Konno operations demonstrates reduced LV global longitudinal strain suggestive of chronically increased afterload independent of autograft function. Additionally, Ross-Konno operation is associated with impaired LV intraventricular mechanics and electrical dyssynchrony.
罗斯和罗斯-科诺手术与残余室间隔功能障碍和传导系统损伤的固有风险相关。然而，罗斯和罗斯-科诺手术后磁共振成像上综合的双心室功能结果尚不清楚。本研究的目的是评估和比较罗斯和罗斯-科诺手术后患者的电机械不同步程度，使用心脏磁共振成像。
行罗斯手术的患者（n=16）、罗斯-科诺手术的患者（n=13）和健康对照组（n=12）接受心脏磁共振成像应变变形分析，以量化左心室（LV）室内不同步和右心室（RV）-LV 室间不同步。机械不同步指数与 QRS 持续时间评估的电不同步程度相关，以及与磁共振成像衍生的双心室和自体移植物反流参数相关。
与对照组相比，罗斯组和罗斯-科诺组患者的 LV 整体纵向应变降低（均 P 值<0.01）。与对照组相比，罗斯组（P<0.05）和罗斯-科诺组（P<0.01）的 RV-LV 室间不同步增加。与对照组和罗斯组相比，罗斯-科诺组患者的 LV 室间隔室内不同步也增加（均 P 值<0.01）。整体 LV 内机械不同步与 QRS 持续时间强烈相关（R=0.716；P<0.001）。机械不同步与主动脉瓣反流分数之间无关联。
对行罗斯和罗斯-科诺手术的患者进行长期随访，发现 LV 整体纵向应变降低，提示独立于自体移植物功能的慢性后负荷增加。此外，罗斯-科诺手术与 LV 室内机械和电不同步受损有关。
