Key result
Comprehensive assessment using four-dimensional flow MRI guided successful right ventricular outflow tract reconstruction, which reduced right ventricular end-diastolic volume index from 147 to 113.5 mL/m2 at 3 months.
Why the study?
Right ventricular outflow tract re-intervention indications after the Ross procedure remain unclear in the long term, requiring comprehensive assessment of total hemodynamics.
Case Report (n=1)
May support multimodal imaging for RV assessment post-Ross in adults; leaves open whether it improves outcomes or warrants routine use.
BACKGROUND: Re-intervention after Ross procedure into the right ventricular outflow tract might be needed in patients in the long term. However, right ventricular outflow tract re-intervention indications are still unclear. Comprehensive assessment of total hemodynamics is needed. A 42-year-old Japanese woman was referred to our hospital for moderately severe pulmonary regurgitation and severe tricuspid regurgitation after a Ross-Konno procedure. Thirteen years after surgery, she developed atrial fibrillation and atrial flutter and complained of dyspnea. Electrophysiological studies showed re-entry circuit around the low voltage area of the lateral wall on the right atrium. Four-dimensional flow magnetic resonance imaging revealed moderate pulmonary regurgitation, severe tricuspid regurgitation, and a dilated right ventricle. Flow energy loss in right ventricle calculated from four-dimensional flow magnetic resonance imaging was five times higher than in normal controls, suggesting an overload of the right-sided heart system. Her left ventricular ejection fraction was almost preserved. Moreover, the total left interventricular pressure difference, which shows diastolic function, revealed that her sucking force in left ventricle was preserved. After the comprehensive assessments, we performed right ventricular outflow tract reconstruction, tricuspid valve annuloplasty, and right-side Maze procedure. A permanent pacemaker with a single atrial lead was implanted 14 days postoperatively. She was discharged 27 days postoperatively. Echocardiography performed 3 months later showed that the size of the dilated right ventricle had significantly reduced. DISCUSSION: A four-dimensional imaging tool can be useful in the decision of re-operation in patients with complex adult congenital heart disease. The optimal timing of surgery should be considered comprehensively.
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Takigami et al. (2020) conducted a case report in Right ventricular outflow tract stenosis and right ventricular failure after Ross procedure (n=1). Right ventricular outflow tract reconstruction, tricuspid valve annuloplasty, and right-side Maze procedure was evaluated on Right ventricular size (RVEDVI/RVESVI). Comprehensive assessment using four-dimensional flow MRI guided successful right ventricular outflow tract reconstruction, which reduced right ventricular end-diastolic volume index from 147 to 113.5 mL/m2 at 3 months.
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