Pre-operative Pediatric Ross Evaluation: Does Echocardiogram or Cardiac CT More Closely Approximate Direct Surgical Measurement?

Pre-operative valve assessment is critical for surgical planning prior to the Ross procedure. No pediatric studies have assessed preoperative sizing comparing different imaging modalities. Single center study including all patients undergoing the Ross procedure from January 2018 – December 2023. Demographics and measurements of the aortic and pulmonary valve dimensions using transthoracic echocardiography (TTE), cardiac CT (CCT), and direct surgical measurement were included. Bland Altman Plots and intraclass correlation coefficient (ICC) assessed agreement between direct surgical measurement, TTE, and CCT, and between investigators. Of the 71 Ross patients during the study period, 62 patients met surgical inclusion criteria and of those, 58 met TTE inclusion criteria, 39 met CCT inclusion criteria, and 35 met both TTE and CCT criteria. CCT overestimated aortic and pulmonic valve annular dimensions while TTE more closely approximated direct surgical measurement. ICC demonstrated poor agreement between direct surgical measurement and pulmonary valve CCT. Agreement for CCT evaluation of the aortic valve was fair (0.74) and for TTE was fair to good for both valve measurements (range 0.71 to 0.88). TTE evaluation of the aortic and pulmonary valve annular measurements had better agreement with surgical measurements when compared to CCT. While CCT may not be required for pre-operative valve sizing in these patients, CCT plays an important role in delineating coronary, sternal, and other anatomic variables. Both modalities provide valuable complementary pre-operative information.