Journal article
Pre-operative Pediatric Ross Evaluation: Does Echocardiogram or Cardiac CT More Closely Approximate Direct Surgical Measurement?
Pediatric cardiology
09/04/2026
DOI: 10.1007/s00246-026-04456-0
PMID: 42696154
Appears in UI Libraries Support Open Access
Abstract
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.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.
Details
- Title: Subtitle
- Pre-operative Pediatric Ross Evaluation: Does Echocardiogram or Cardiac CT More Closely Approximate Direct Surgical Measurement?
- Creators
- Rachel E Henning - University of IowaNicholas B Aizcorbe - University of UtahMatthew D Beaver - University of UtahB Kelly Han - University of UtahAaron W Eckhauser - University of UtahS Adil Husain - University of UtahEric R Griffiths - University of UtahReilly D Hobbs - University of UtahZhining Ou - University of UtahLaura N Milles - Primary Children's HospitalRichard V Williams - University of UtahSpencer B Barfuss - University of Utah
- Resource Type
- Journal article
- Publication Details
- Pediatric cardiology
- DOI
- 10.1007/s00246-026-04456-0
- PMID
- 42696154
- NLM abbreviation
- Pediatr Cardiol
- ISSN
- 1432-1971
- eISSN
- 1432-1971
- Publisher
- Springer Nature
- Grant note
- Heart Center at Primary Children's Hospital University of Utah Pediatric Cardiology Division National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health: UL1TR002538
We would like to thank the Heart Center at Primary Children's Hospital and the University of Utah Pediatric Cardiology Division for their funding and support of this research project. This investigation was supported by the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR002538 (formerly 5UL1TR001067-05, 8UL1TR000105 and UL1RR025764).
- Language
- English
- Electronic publication date
- 09/04/2026
- Academic Unit
- Cardiology; Stead Family Department of Pediatrics
- Record Identifier
- 9985222047802771
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