Late Dynamic Right Ventricular Outflow Obstruction After the Ross Procedure for Bicuspid Aortic Valve Disease

Abstract

An asymptomatic 26-year-old man was under routine surveillance following a Ross procedure at 17 years of age for bicuspid aortic valve disease. During transthoracic echocardiography there was a suspicion of homograft stenosis following the finding of a high-velocity turbulent jet in the main pulmonary artery (MPA) (Figure 1A and 1B; online-only Data Supplement Movie IA and IB). The pressure gradient by ultrasound Doppler was calculated to be 60 mm Hg, but the cause could not be clearly elucidated. The ECG (Figure 2) showed sinus rhythm with a normal axis, normal P-wave morphology, and nonspecific interventricular conduction delay in V1-V2. Chest radiograph (Figure 3) did not reveal any distortion of the great vessels or show signs of heart failure. Figure 1. A , Transthoracic echocardiography (parasternal-right ventricular outflow tract view) showing compression (horizontal arrow) of the main pulmonary artery. B , Color Doppler shows increased velocity in the main pulmonary artery (vertical arrow), but the study could not identify a clear cause. Figure 2. Standard 12-lead ECG. Figure 3. Chest radiograph (posteroanterior projection) showing a normal cardiothoracic ratio with no evidence of distortion of the pulmonary arteries or proximal aorta. A cardiovascular magnetic resonance (CMR) scan was organized to clarify the echocardiographic findings. CMR was …