DOES THE PULMONARY AUTOGRAFT IN THE AORTIC POSITION IN ADULTS INCREASE IN DIAMETER - AN ECHOCARDIOGRAPHIC STUDY

Objective: The objective of this study was to discern the fate of the pulmonary autograft diameter over time in adults and its relation to a ortic regurgitation in the setting of aortic root replacement. Methods : From January 1989 to May 1995, 36 consecutive adult patients underwe nt aortic root replacement with a pulmonary autograft for aortic valve disease. The mean age of 20 male and 16 female patients was 29.1 year s (range 19.3 to 52.1 years). The mean follow-up was 2.3 years (range 0.3 to 6.0 years). Two patients died in the hospital. One other patien t had a second operation for stenosis at the distal suture line of the allograft in the pulmonary position. Pulmonary autograft anulus and s inus diameters were measured with epicardial echocardiography before ( only anulus) and after cardiopulmonary bypass, with transthoracic echo cardiography at hospital discharge, and with transesophageal echocardi ography during follow-up. Results: The mean autograft anulus diameter did not increase immediately after cardiopulmonary bypass (mean diamet er 26.2 mm before and 26.4 mm after cardiopulmonary bypass). The mean autograft sinus diameter after cardiopulmonary bypass was 36.5 mm. The mean autograft anulus diameter increased to 31.5 mm at follow-up, an increase of 5.1 mm (19%). The mean autograft sinus diameter increased to 43.9 mm at follow-up, an increase of 7.4 mm (20%). Fifty-nine perce nt of the anulus diameter increase and 40% of the sinus diameter incre ase was already reached at hospital discharge (7 to 10 days after the operation); the other part of the increase occurred during follow-up. Diameter increase was associated with neither the length of follow-up (follow-up less than 1 year compared with a longer follow-up) or sever ity of aortic regurgitation. Conclusion: Pulmonary autograft anulus an d sinus diameters increase the first year after aortic root replacemen t with a pulmonary autograft. This occurs rapidly within 10 days after the operation, with a further increase during follow-up, without caus ing significant aortic regurgitation at medium-term follow-up.