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Functional outcomes after the Ross (pulmonary autograft) procedure assessed with magnetic resonance imaging and cardiopulmonary exercise testing
  1. Rajesh Puranik1,
  2. Victor T Tsang1,2,3,
  3. Andrew Broadley1,2,
  4. Johannes Nordmeyer1,2,
  5. Phillip Lurz1,2,
  6. Nagarajan Muthialu1,3,
  7. Graham Derrick1,2,
  8. Fiona Walker3,
  9. Seamus Cullen1,3,
  10. Marc de Leval1,3,
  11. Phillip Bonhoeffer1,2,3,
  12. Andrew M Taylor1,2,
  13. Vivek Muthurangu1,2
  1. 1Great Ormond Street Hospital for Children, NHS Trust, Cardiorespiratory Unit, London, UK
  2. 2UCL Institute of Child Health, Cardiovascular Unit, London, UK
  3. 3The Heart Hospital, NHS Trust, London, UK
  1. Correspondence to Prof Andrew M Taylor, Cardiovascular Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK; a.taylor{at}


Objective To assess autograft, homograft and ventricular function, as well as exercise capacity, in adult patients who have undergone the Ross procedure.

Setting Single centre paediatric and adult congenital heart disease unit.

Patients 45 subjects (24.6 years, range 16.9–52.2 years) who underwent the Ross procedure between 1994 and 2006 (8.1 years after the Ross operation, range 2.0–14.0 years).

Interventions Cardiovascular magnetic resonance imaging, echocardiography and cardiopulmonary exercise testing.

Main outcome measures Autograft and homograft stenosis, and regurgitation. Autograft size. Biventricular function, scar volume and exercise capacity.

Results Mean autograft regurgitation was 6.8%±8.3% (trivial regurgitation) and diameter was 40.0±7.0 mm. Mean homograft velocity was 2.4±0.6 m/s (mild-moderate stenosis) and regurgitation was 6.1%±8.3% (trivial regurgitation). Biventricular systolic function was normal (LV EF 63.1±6.4% and RV EF 60.1%±7.6%). In 38% of cases there was evidence of LV scar, mostly noted within the inter-ventricular septum. The mean exercise capacity achieved was 87%±22% of predicted. There was no correlation between exercise capacity and ventricular function or scar.

Conclusion This study demonstrates minor autograft and homograft dysfunction in the majority of patients after the Ross procedure, associated with good ventricular function and exercise capacity. In addition, minor scar was present in a third of patients with no functional consequences.

  • Ross procedure
  • magnetic resonance imaging
  • echocardiography
  • cardiopulmonary exercise testing
  • functional outcome
  • surgery paediatric
  • exercise testing
  • MRI
  • MR
  • magnetic resonance
  • b-SSFP
  • balanced steady state free precession
  • LV
  • left ventricle
  • RV
  • right ventricle
  • RF
  • regurgitation fraction
  • EDV
  • end diastolic volume
  • ESV
  • end systolic volume
  • SV
  • stroke volume
  • EF
  • ejection fraction
  • CPEX
  • cardiopulmonary exercise testing
  • ECG
  • electrocardiogram

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  • See Editorial, page 253

  • 186569.

  • Funding RP is funded by the Neil Hamilton Fairley NHMRC/NHF of Australia Postdoctoral Fellowship. PL is funded by the European Union (Health-e-Child Initiative). VM is a BHF intermediate research fellow. AMT is funded by the UK National Institute of Health Research (NIHR) and British Heart Foundation (BHF).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the National Research Ethics Committee UK.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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