Accuracy of intraoperative transesophageal echocardiography in the prediction of future neo-aortic valve function after the ross procedure in children and young adults

Bradley S. Marino*, Sara K. Pasquali, Gil Wernovsky, Jack Rychik, Lisa Montenegro, David Shera, Thomas L. Spray, Meryl S. Cohen, Anita Pudusseri

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Objective. Neo-aortic insufficiency (neo-AI) has been noted following the Ross procedure. The purpose of this study was to evaluate the ability of intraoperative transesophageal echocardiography (TEE) to predict future neo-AI in pediatric patients undergoing the Ross from January 1995 to December 2003, who had an intraoperative TEE, and discharge and follow-up transthoracic (TTE) echocardiograms. Design. Retrospective case series. Patients. All patients who underwent the Ross procedure at Children's Hospital of Philadephia between January 1995 and December 2003, and had an intraoperative TEE, discharge, and follow-up (>6 months) transthoracic echocardiogram (TTE) (by July 1, 2004) were included. Outcome Measures. Grade of neo-AI was assessed on intraoperative TEE, discharge, and follow-up TTE echocardiogram reports. Results. Follow-up was available in 99/115 (86%) survivors. Median age at Ross was 9.3years (4days-34years). No patient had more than mild neo-AI on intraoperative TEE. At discharge, 2 patients (2%) had moderate neo-AI. At most recent follow-up (median 4.2 years, 8 months-9.3 years), 21 patients (21%) had moderate or greater neo-AI; 9 underwent neo-aortic reintervention. The presence of any neo-AI on intraoperative TEE had 100% sensitivity and negative predictive value for diagnosing moderate or greater neo-AI at discharge. Patients who had mild neo-AI on TEE were more likely to have moderate or greater neo-AI at most recent follow-up than those patients with no neo-AI on TEE (9% vs. 30%, P = 0.01). Conclusion. Intraoperative TEE is an excellent screening tool for the presence of significant neo-AI at the time of hospital discharge. Neo-AI progresses over time after Ross procedure and is more likely to progress in those patients with neo-AI on intraoperative TEE. However, predictive validity decreases over time as neo-AI progresses.

Original languageEnglish (US)
Pages (from-to)39-46
Number of pages8
JournalCongenital Heart Disease
Volume3
Issue number1
DOIs
StatePublished - Jan 1 2008

Keywords

  • Negative Predictive Value
  • Neo-aortic Valve Insufficiency
  • Positive Predictive Value
  • Ross Procedure
  • Sensitivity
  • Specificity
  • Transesophageal Echocardiography

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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