Search PubMed⌕ Search

Biomedical subjects

H H Sievers

Publications and source records attributed to H H Sievers.

At least 19 recordsLinked to original sources
PubMed2001

Time course of aortic valve function and root dimensions after subcoronary ross procedure for bicuspid versus tricuspid aortic valve disease.

BACKGROUND: The freestanding aortic root, which is the currently preferred operative technique for pulmonary autografts, is reported to dilate and potentially promote aortic insufficiency, which has led to a controversial debate on the appropriate surgical technique, especially for congenital bicuspid aortic valve disease. Desirable data on the time course of valve function and root dimensions for the alternative subcoronary technique comparing bicuspid and tricuspid aortic valve disease are scarce. METHODS AND RESULTS: Echocardiographic examinations of 31 patients with congenital bicuspid aortic valve disease (group A; age 50.5+/-11.0 years) and 51 patients with acquired tricuspid aortic valve disease (group B; age 48.1+/-15.7 years) who were operated on between June 1994 and August 1998 were performed twice postoperatively. At first and second follow-up, respectively, maximum (mean) pressure gradients were 6.0+/-2.0 (3.6+/-1.0) and 5.1+/-2.1 (2.9+/-1.1) mm Hg in group A and 6.5+/-3.5 (3.9+/-1.9) and 5.0+/-1.7 (2.9+/-1.0) mm Hg in group B (P>0.05 between groups). In group A, grade 0 aortic insufficiency at first and second follow-up occurred in 8 and 7 patients, respectively, grade 0-I in 12 and 9 patients, grade I in 9 and 11 patients, grade I-II in 1 and 0 patients, and grade II in 1 and 4 patients; in group B, grade 0 aortic insufficiency occurred in 16 and 18 patients, grade 0-I in 16 and 8 patients, grade I in 17 and 21 patients, grade I-II in 0 and 1 patient, and grade II in 0 and 1 patient (P>0.05). Aortic insufficiency decreased in 10 patients (17%). However, there was an overall tendency for aortic insufficiency to increase over time (n=23, 38%), although it remained subclinical. Aortic root dimensions did not differ between groups and were constant during follow-up. CONCLUSIONS: This study provides some evidence that the function of the subcoronary pulmonary autograft in bicuspid aortic valve disease is excellent, with stable root dimensions, and is not different from that of tricuspid aortic valves at least up to 5.5 years postoperatively, which suggests the subcoronary technique should be reconsidered.

Adult↗
PubMed2001

Does histocompatibility affect homograft valve function after the Ross procedure?

BACKGROUND: Homograft valves have been shown to be immunogenic, but it is unknown whether this affects valve function. Therefore, we prospectively studied the degree of histoincompatibility (defined as the number of human leukocyte antigen [HLA] mismatches between valve donor and recipient) and the response of the recipient (measured by antibodies against HLA) in relation to echocardiographic parameters of homograft valve function after the Ross procedure. METHODS AND RESULTS: Twenty-six patients (mean age 41+/-14 years; 20 males, 6 females) and the cryopreserved pulmonary homograft valves that were implanted during a Ross procedure were typed for HLA-A, HLA-B, and HLA-DR. After a mean follow-up of 15+/-6 months, 14 (54%) of the patients were anti-HLA class I antibody positive. In all but 1 patient, these antibodies were shown to be donor specific. During follow-up, there was a significant increase of the maximal (+6.2+/-7.1 mm Hg) and mean (+3.2+/-4.3 mm Hg) transhomograft pressure gradients but not of homograft regurgitation. Neither the number of HLA mismatches nor antibody status was found to have significant impact on homograft valve function. In a multivariate analysis, smaller homograft size (P=0.001) and younger recipient age (P=0.044) were shown to be significantly associated with increased transhomograft pressure gradients. CONCLUSIONS: Implantation of a cryopreserved pulmonary homograft during the Ross procedure can induce a specific humoral response. We observed a significant increase of the transhomograft pressure gradients within 15+/-6 months after surgery. For this period, we were unable to demonstrate a relationship between this increase and the degree of histoincompatibility.

Adult↗
PubMed2001

Biomechanical hearts: muscular blood pumps, performed in a 1-step operation, and trained under support of clenbuterol.

BACKGROUND: As shown previously in goats, clenbuterol increased the power of electrically conditioned skeletal muscle ventricles (SMVs) of clinically relevant size (150 mL), which were constructed around a mock system. They pumped against a pressure of 60 to 70 mm Hg immediately during surgery and up to several months after, finally at >1 L/min. SMVs without clenbuterol administration failed. Thus, we expected that clenbuterol-supported SMVs might become integrated into the circulation by a 1-step operation instead of the 2-step procedure required up to now. METHODS AND RESULTS: In adult Boer goats (n=5), latissimus dorsi muscle was wrapped around a polyurethane chamber of 150 mL that was connected to the descending aorta. This muscular flow-through pumping chamber containing a stabilizing inner layer (called a biomechanical heart [BMH]) was formed and immediately made to work against a systemic load with the support of clenbuterol (5x150 microg/wk). During surgery, the mean stroke volume of BMHs was 53.8+/-22.4 mL. One month after surgery, in peripheral arterial pressure, the mean diastolic (P(MD)) and minimal diastolic (P(min)) pressures of BMH-supported heart cycles differed significantly from unsupported ones (P(MD)=+2.9+/-1.1 mm Hg [P<0.04], P(min)=-2.4+/-0.9 mm Hg [P<0.04]). After BMH-supported heart contractions, the subsequent maximal rate of pressure generation, dP/dt(max), increased by 20.5+/-8.1% (P<0.02). One BMH, catheterized 132 days after surgery, shifted a volume of 34.8 mL per beat and 1.4 L/min with a latissimus dorsi muscle of 330 g. Depending on duration of training, the percentage of myosin heavy chain type 1 ranged between 31% and 100%. CONCLUSIONS: Under support of clenbuterol, BMHs of a clinically relevant size can be trained effectively in the systemic circulation after a 1-step operation and offer the prospect of a sufficient volume shift and probably unloading of the left ventricle.

Animals↗
PubMed2001

Quality of life in aortic valve replacement: pulmonary autografts versus mechanical prostheses.

OBJECTIVES: We sought to determine whether the quality of life (QoL) is different in patients after aortic valve replacement with mechanical prostheses or pulmonary autografts. BACKGROUND: Quality of life after mechanical valve replacement may be affected by the risk of thromboembolism and anticoagulation, and after autograft implantation, by the risk of degeneration and re-operation especially of the homograft. METHODS: Two groups of 40 patients each--one after the autograft procedure (group I) and one after mechanical valve implantation (group II)--were matched for age, gender and length of follow-up. At latest follow-up, all patients underwent routine echocardiography, the short-form health survey (SF-36) QoL survey and an extensive psychological investigation. RESULTS: Patients with an autograft showed better QoL scales, as compared with mechanical valve recipients. The difference was significant for both the physical (72.72+/-20.00 vs. 60.27+/-26.07, p = 0.021) and psychological health sum scores (74.71+/-21.03 vs. 64.71+/-23.49, p = 0.046) and for the subtests of physical functioning (73.72+/-22.44 vs. 62.77+/-25.42, p = 0.049), physical pain (88.39+/-19.13 vs. 73.36+/-27.08, p < or = 0.006), general health perception (64.37+/-17.88 vs. 51.86+/-22.86, p < or = 0.008) and health change (61.89+/-18.94 vs. 50.11+/-24.37, p = 0.02). The QoL variables did not correlate to pressure gradients, ejection fraction and New York Heart Association functional class. Psychometric tests revealed no meaningful differences between the groups. CONCLUSIONS: This study provides some evidence that patients with pulmonary autografts have greater benefit in terms of QoL, as compared with recipients of mechanical valve substitutes.

Aortic Valve↗
PubMed2001

Survival after transmyocardial laser revascularization in relation to nonlasered perfused myocardial zones.

BACKGROUND: Transmyocardial laser revascularization for severe diffuse coronary artery disease reduces angina significantly. The effect on survival, however, is questionable, and risk factors are not adequately addressed. Considering that transmyocardial laser revascularization channels do not remain patent for improving direct myocardial blood supply, other variables such as perfusion through open native or grafted vessels in remote non-transmyocardial laser revascularization areas are probably more important for survival. This hypothesis is the subject of the study. METHODS: Transmyocardial laser revascularization was performed with a CO2 laser system in 63 patients between October 1995 and December 1997. Patients received transmyocardial laser revascularization alone or in combination with coronary artery bypass grafting. The heart was divided into three perfusion zones as determined by the three major coronary arteries. Patients were divided into three groups according to the number of zones that were perfused by either a native coronary artery or a patent bypass graft: group 1 (n = 9), none; group 2 (n = 24), one; and group 3 (n = 30), two. Follow-up was performed at 3, 6, 12, 24, and 36 months and was 100% complete. Mean latest follow-up was 26.2 months, minimal follow-up of survivors was at least 12 months. RESULTS: Overall mortality was remarkably higher in group 1 (77.8%) compared with group 2 (20.8%, p = 0.005) and group 3 (13.3%, p = 0.001). Hospital mortality was 22.2% in group 1, 0% in group 2, and 3.3% in group 3. Late mortality was also higher in group 1 (55.5% versus 20.8%, and versus 9.9%, respectively). Cardiac deaths were more frequent in group 1 (55.5% versus 12.5% in group 2, p = 0.02, and versus 9.9% in group 3, p = 0.009). The number of perfused myocardial zones showed a significant influence for survival (p = 0.002). CONCLUSIONS: These data give some directional evidence that survival seems to be beneficially affected by the number of nonlasered perfused myocardial zones through native vessels or grafts in patients undergoing transmyocardial laser revascularization.

Aged↗
PubMed2001

Anti-HLA class I antibodies and pulmonary homograft function after the Ross procedure.

BACKGROUND: The Ross procedure provides excellent long-term results in the majority of patients. However, degeneration of the pulmonary homograft in some patients remains an unresolved problem that may be related to immunologic factors. Therefore, we studied the prevalence of antihuman leukocyte antigen (HLA) class I antibodies and echocardiographic results of homograft function at rest. METHODS: Forty-seven patients (37 men, 10 women; 47 +/- 15 years) were seen for echocardiography 1.1 to 63.9 months (median, 27 months) postoperatively. The presence of anti-HLA antibodies was tested against a panel of lymphocytes of 50 donors. RESULTS: Twenty-seven (57%) of the patients produced anti-HLA class I antibodies. No difference in the maximal or mean transhomograft pressure gradient, or in the frequency of homograft regurgitation according to the presence or absence of anti-HLA antibodies was found. However, the right ventricle was slightly but significantly larger in antibody-positive patients (26.3 +/- 4.2 versus 30.7 +/- 3.5 mm; p = 0.001). CONCLUSIONS: In the first years after the Ross procedure, we could not detect significant evidence of an association between anti-HLA class I antibodies and echocardiographic results of homograft function at rest in adults.

Adult↗
PubMed2001

Influence of modified ultrafiltration on coagulation, fibrinolysis and blood loss in adult cardiac surgery.

OBJECTIVES: Modified ultrafiltration (MUF) significantly reduce blood loss and transfusion requirements in pediatric cardiac surgery presumably by a reduction in inflammatory mediators which decrease the inflammatory axes and decrease the cross-activation of fibrinolysis and thrombosis. The influence of MUF on blood loss and homologous blood transfusion in adult cardiac surgery has not yet been determined. Furthermore, data about the influence on routine coagulation tests, platelet activation as well as the coagulation and fibrinolytic systems are limited. METHODS: In a prospective randomized study 48 patients scheduled for elective myocardial revascularization were randomized into a control group (n=16), a conventional ultrafiltration (CUF) group (n=16) and a MUF group (n=16). Perioperatively, serial blood samples were drawn at specific intervals to evaluate coagulation, fibrinolysis, and platelet function. RESULTS: Neither the coagulation nor the fibrinolytic system was positively influenced by MUF or CUF. The routine clotting tests were comparable except for a significantly higher antithrombin III activity after MUF compared to the CUF control group persisting 24 h postoperatively. Platelet factor 4 activity and platelet counts showed no differences among the groups. MUF considerably reduced the postoperative blood loss (MUF, 6.4+/-1.7 ml/kg bw per 24 h vs. CUF, 9.2+/-2.5 ml/kg bw per 24 h (P=0.003) vs. control, 8.9+/-2.2 ml/kg bw per 24 h (P=0.008)) and allogeneic blood transfusion (MUF, 2.0+/-3.4 ml/kg bw per 24 h vs. CUF, 6.9+/-5.1 ml/kg bw per 24 h (P=0.034) vs. control, 7.0+/-6.3 ml/kg bw per 24 h (P=0.029)). CONCLUSIONS: MUF in adult cardiac surgery significantly reduces postoperative blood loss and transfusion requirements. The mechanism for reduced blood loss could not be elucidated in this study.

Antithrombin III↗
PubMed2001

Hemodynamics of semilunar valves at rest and exercise at an average of more than two years after the Ross procedure.

BACKGROUND AND AIM OF THE STUDY: Rest, and especially exercise, hemodynamics are valuable determinants to assess outcome of the Ross procedure. In this study, the degree of insufficiency and pressure gradients at rest across the autograft and homograft, as well as the pressure gradients at exercise, were measured. METHODS: Among 115 patients operated on between February 1990 and February 1999, 67 were evaluated echocardiographically at rest and moderate exercise. The mean patient age at subcoronary implantation was 52 +/- 13 years. The mean interval between surgery and investigation was 27.3 +/- 17.4 months. The exercise level was 100 W (n = 47), 75 W (n = 14) or 50 W (n = 6). RESULTS: Fifty-two patients had no or trace aortic insufficiency, 23 were grade I/IV, and two were grade II/IV. Pulmonary insufficiency was graded as none (n = 45), mild (n = 21), and moderate (n = 1). Heart rate increased from 70 +/- 12 beats/min at rest to 108 +/- 19 beats/min at exercise. The maximal pressure gradient across the autograft increased from 6.1 +/- 2.3 mmHg at rest to 8.7 +/- 4.1 mmHg at exercise. The maximal pressure gradient across the homograft increased from 11.8 +/- 5.3 mmHg at rest to 17.7 +/- 8.2 mmHg at exercise. A pressure gradient across the homograft >25 mmHg was measured in 13 patients. CONCLUSION: In most patients, hemodynamics at rest and moderate exercise at an average of more than two years after the Ross procedure were excellent. Some homografts developed pressure gradients at exercise; this finding will form the target of future surgical and scientific investigations.

Adult↗
PubMed2001

Effect of cardiopulmonary bypass on a patient with endocarditis and malaria.

Knowledge about the effects of cardiopulmonary bypass on malarial patients is scant. Malaria-induced hemolysis can exercerbate by performing extracorporeal circulation on a patient infected with Plasmodium and may, therefore, lead to a critical hemolysis jeopardizing the clinical outcome. A 52-year-old patient suffering from malaria and endocarditis was scheduled for urgent aortic valve replacement. During extracorporeal circulation, free hemoglobin showed an increase to maximum of 392.5 mg/L (normal range < 50 mg/L), while haptoglobin decreased to the lowest value of 0.56 g/L (normal range 0.3-2.0 gL). Although hemolysis increased, pump run, weaning, and the postoperative course were uneventful.

Aortic Valve↗
PubMed2000

Clenbuterol-supported dynamic training of skeletal muscle ventricles against systemic load: a key for powerful circulatory assist?

BACKGROUND: The profound loss of power that occurs in skeletal muscle after electrical conditioning has been the major limiting factor in its clinical application. This study investigates a 3-fold approach for chronic conditioning of skeletal muscle ventricles (SMVs) combining electrical transformation, dynamic training against systemic load, and pharmacological support with clenbuterol. METHODS AND RESULTS: In 10 adult male goats, SMVs were constructed from latissimus dorsi muscle wrapped around an intrathoracic training device with windkessel characteristics. SMVs were stimulated electrically and trained dynamically by shifting volume against systemic load. Group 1 goats were controls (n=5), and group 2 goats (n=5) were supported with clenbuterol (150 microg 3 times a week). SMV dynamics were recorded weekly over 5 to 8 months: peak pressure (P(max)), stroke volume (SV), volume displacement per minute (VD), stroke work per day (SW/d), and maximum rates of pressure generation, +dP/dt(max), and decay, -dP/dt(max). In group 1, after 149.5+/-2.7 days (n=4), data were P(max)=70.8+/-4.7 mm Hg, SV=3.2+/-1.2 mL, VD=62.3+/-21.1 mL/min, SW/d=0.8+/-0.4 kJ, +dP/dt(max)=64+/-13 mm Hg/s, and -dP/dt(max)=156+/-32 mm Hg/s. These parameters were significantly improved (P<0.007) in the clenbuterol-treated group 2 after 151+/-2.7 days: P(max)=176.2+/-43.8 mm Hg, SV=23.3+/-6.1 mL, VD=568.2+/-186.1 mL/min, SW/d=9.1+/-2.2 kJ, +dP/dt(max)=1134+/-267 mm Hg/s, and -dP/dt(max)=1028+/-92 mm Hg/s. In 2 SMVs of group 2, VD increased to 1090 and 1235 mL/min after 202 and 246 days of training, respectively. At termination, myosin heavy chains were totally transformed into myosin heavy chain-1 in all SMVs. CONCLUSIONS: This clenbuterol-supported dynamic training provides powerful SMVs that may have important clinical implications for the treatment of end-stage heart failure by muscular blood pumps.

Animals↗
PubMed2000

Association of serology with the endovascular presence of Chlamydia pneumoniae and cytomegalovirus in coronary artery and vein graft disease.

BACKGROUND: Chemotherapeutic treatment for patients with symptomatic coronary artery disease to reduce cardiovascular events may be initiated in response to elevated antibody titers against Chlamydia pneumoniae or cytomegalovirus. How antibody titers are associated with the endovascular presence of these microorganisms is still unclear. METHODS AND RESULTS: Antibody titers against C pneumoniae (microimmunofluorescence) and cytomegalovirus (ELISA) in patients undergoing primary (coronary desobliterates, n=80) or repeated CABG (occluded vein grafts, n=45) were correlated with the endovascular presence of the 2 microorganisms. C pneumoniae was detected by means of a nested polymerase chain reaction (PCR) and by culturing. Both conventional PCR and quantitative PCR were applied for detection of cytomegalovirus. C pneumoniae (PCR/culture) was detected in 19/9% (15/80 and 7/80) of coronary desobliterates and in 18/11% (8/45 and 5/45) of occluded vein grafts. There was no statistical evidence that IgG values differed between patients with or without C pneumoniae detection who were undergoing primary CABG. In contrast, repeated-CABG patients with a positive PCR (P=0.0027) or C pneumoniae culture (P=0.0018) had distinctly elevated IgG titers compared with patients in whom C pneumoniae was not detected. Cytomegalovirus could not be detected in the examined specimens. CONCLUSIONS: Cytomegalovirus infection does not seem to be associated with advanced coronary artery lesions. C pneumoniae antibody titers are not associated with the endovascular presence of C pneumoniae in patients with coronary artery disease. The observed strong association between elevated IgG titers and the detection of C pneumoniae in occluded vein grafts warrants further investigation.

Aged↗
PubMed2000

[Intermediate term clinical results after endoaneurysmorrhaphy in left ventricular aneurysm].

Endoaneurysmorrhaphy (EAR) in postinfarct ventricular aneurysms leads to excellent short-term results. However, the temporal response of EAR is widely unknown. Thus, the indication for surgical treatment of patients with ventricular aneurysms is not well defined. EAR was performed in 157 patients (6/1993-6/1999) with symptomatic ventricular aneurysms (median NYHA III). Factors influencing cardiac mortality and morbidity during follow-up were determined by univariate and multivariate analysis. Perioperative mortality was low: 5%. Mortality during follow-up was 3.3% per year, resulting in a 5-year survival rate of 78%. NYHA classification ameliorated significantly from the preoperative status compared to the follow-up period (median NYHA II; p < 0.001). Multivariate analysis identified preexisting arterial occlusive disease and advanced age (> 70 years) as significant factors influencing medium-term mortality. Implantation of the left internal mammary artery was associated with a better survival rate. Endoaneurysmorrhaphy can be performed with low perioperative mortality, will result in a significant amelioration of the cardiac clinical status and offers low medium-term mortality. Our data indicate that EAR seems to be the procedure of choice for patients with symptomatic ventricular aneurysms.

Aged↗
PubMed2000

[Ross operation in aortic valve diseases].

UNLABELLED: Currently used standard mechanical and bioprosthetic heart valves all have limitations that produce less than optimal results. The pulmonary autograft offers a promising alternative with theoretical advantages that have to be proven for final judgement of this innovative surgical technique. METHODS AND RESULTS: A survey including the international registry with 2523 patients enrolled since 1987 is provided along with the author's 10 years experience of 157 patients. The age of the patients ranges between one and 79 years. The indication is expanding integrating concomitant procedures like repair or replacement of aneurysms of the aortic root and ascending aorta, mitral valve reconstruction, coronary bypass grafting, etc. The operative mortality ranges between 0.6 and 2.5%. No anticoagulation is necessary. The function of the autograft is excellent. Late incidence of significant aortic insufficiency (> 2+) remains less than 5%. Even at exercise there is no pressure gradient across the autograft. Autograft failure with autograft revision or replacement stands at 1-4%. Homograft function is also found to be excellent. Right ventricular outflow tract revision rate ranges between 1-1.3%. In a few patients (7%), maximal pressure gradients between 20 and 35 mmHg developed across the homograft without major impairment of right ventricular function. CONCLUSIONS: The multicenter data confirm the superior performance of the autograft not matched by any other biological or mechanical valve replacement. Scientific efforts are required to further improve long-term function especially of the neopulmonary valve.

Adolescent↗
PubMed2000

Hydrodynamics of aortic arch vessels during perfusion through the right subclavian artery.

BACKGROUND: Performing subclavian artery cannulation in patients with an atherosclerotic ascending aorta or acute aortic dissection is of growing interest. To increase knowledge about pressure and flow distribution in the arch vessels, we investigated the in vitro perfusion characteristics in right subclavian artery cannulation. METHODS: Pressures and flow rates in the arch vessels of an aortic arch model were measured during perfusion through the right subclavian artery with different geometries and varying flow rates. Flow visualization was performed by laser light. RESULTS: In normal subclavian artery geometries, pressure and flow showed a significant increase in only the right common carotid artery (8 mm Hg and 25.5 mL/min, respectively, at 5.5 L/min pump flow). In cases of 50% stenosis at the right subclavian artery origin, a reduction of pressure and flow (6 mm Hg and 22.5 mL/min, respectively, at 5.5 L/min pump flow) in the right carotid artery caused by a suction effect was observed. CONCLUSIONS: Right subclavian artery cannulation provides a valuable alternative for ascending aortic cannulation, enabling nearly balanced arch vessel perfusion. Stenosis at the right subclavian artery origin carries the potential risk of slightly reduced perfusion of the right common carotid artery with questionable clinical relevance.

Adult↗
PubMed2000

Valve-sparing aortic root replacement (remodeling/reimplantation) in acute type A dissection.

BACKGROUND: High reoperation rates after supracommissural tube graft replacement for acute type A dissection due to sinus of Valsalva dilation have been reported. Valve-sparing operations focusing on the replacement of the sinus of Valsalva are an appealing alternative. The applicability of these techniques in acute type A dissection remains debatable and results are limited. METHODS: From 1992 to 1998, 20 patients with acute type A dissection received a valve-sparing aortic root replacement. Two different types of aortic valve-sparing operations were performed: the remodeling technique in 11 patients and the reimplantation technique in 9 patients. Patients were followed for 26 +/- 18 months. Echocardiographic studies were performed every 6 months. RESULTS: There were 2 early postoperative deaths and no late death, no reoperation, and no thromboembolic events. The latest echocardiographic studies of the 18 survivors showed a competent valve in 12 and a trivial aortic valve insufficiency in 6 patients. The mean aortic valve pressure gradient was 4.3 +/- 1.3 mm Hg. CONCLUSIONS: These midterm results support the surgical strategy of valve-sparing aortic root replacement in patients with acute type A dissection.

Aortic Dissection↗
PubMed2000

Size and distensibility of the aortic root and aortic valve function after different techniques of the ross procedure.

OBJECTIVES: In the Ross procedure, 3 different techniques are used for aortic valve replacement with the pulmonary autograft: freestanding root, inclusion, and subcoronary implantation. The objective of this study was to evaluate echocardiographically the influence of the particular operative technique on dimension, distensibility, and valve function. METHODS: Between February 1990 and August 1998, the Ross procedure was performed in 111 patients (mean age, 48.6 +/- 14.1 years; range, 15.2-70.6 years), with 1 early and 1 late death, 1 autograft replacement, and 1 patient lost to follow-up. The remaining patients underwent the freestanding root (n = 9 patients), inclusion (n = 14 patients), and subcoronary techniques (n = 84 patients). Echocardiography was performed at a mean follow-up of 26 +/- 21.3 months after operation and was compared with the echocardiographic findings of the control subjects (n = 10 subjects). Root sizes were measured at the level of the anulus, sinus, and supra-aortic ridge; the distensibility was calculated as pressure strain elastic modulus and percent change of radius. RESULTS: Size and distensibility of the aortic root were normal, except for a larger diameter at the sinus level in the root technique in comparison to the subcoronary technique (P <.05; maximum diameter, 41.3 +/- 8.6 mm vs 32.6 +/- 4.0 mm). Aortic valve function was comparable among groups with low pressure gradients and most patients with no or trace aortic insufficiency. CONCLUSIONS: The freestanding root, inclusion, and subcoronary techniques in the Ross procedure provide comparable excellent hemodynamics, normal root size, and distensibility, except for the enlarged sinus diameter in the freestanding root. These results may have some impact on the operative procedure and follow-up investigations.

Adult↗