Rapid enlargement of neoaortic root after the Ross procedure in children

The Ross procedure was first described in 1967(1) and has been used with in creasing frequency in children with aortic valve disease during this decade .(2-8) The use of the pulmonary autograft replacement for a diseased aortic valve in a child is supported by 3 benefits:(1) the risk of arterial throm boembolism is negligible,(9,10) (2) valve degeneration appears to be neglig ible,(5,6,4,9,10) and (3) there is potential for neoaortic annular growth t o accommodate for changes in patient size.(3,7-9,11) The first 2 benefits o f the Ross procedure are consistently demonstrated and accepted. Whether th e neoaortic root changes size appropriately, or if it in fact dilates, has been a topic of debate. Studies in children who have undergone the Ross pro cedure have noted a change-in annulus size and concluded either that an app ropriate annular growth potential exists(5,8) or that annulus dilation may be occurring.(3) Early postoperative increases in annulus size have been sh own in adult patients after the Ross procedure as well, suggesting dilation because these persons have completed somatic growth.(12) The purpose of th is study was to compare changes in the neoaortic annulus dimension over tim e in pediatric patients who have undergone the Ross procedure with aortic r oot replacement with the normal population.