Decoding the Conundrum: Navigating Intra-operatively Encountered Suspicious Gallbladder Wall Thickening with Laparoscopic Transhepatic Needle Decompression and Beyond Cystic Plate Cholecystectomy.

BACKGROUND: Suspicious gallbladder wall thickening encountered during laparoscopic cholecystectomy poses challenges in its management. This study aims to address this problem by proposing a technique that involves laparoscopic transhepatic needle decompression and modified cystic plate cholecystectomy. METHODS: In this report, we describe the case of a 36-year-old female with symptomatic gallstone disease and ultrasound findings of a well-distended gallbladder with a uniform wall thickness. Diagnostic laparoscopy revealed a distended, tense gallbladder with suspicious areas of thickness. Transhepatic aspiration was performed for gallbladder decompression, followed by modified cystic plate cholecystectomy with preservation of the thin rim of liver tissue over the cystic plate. The gallbladder was removed in a specimen bag, and final histopathology showed a hyalinized gallbladder wall with calcification and pyloric gland metaplasia, with liver tissue adhered to the gallbladder wall (Video). RESULTS: The proposed technique aimed to minimize the risk of bile spillage and violation of oncological planes while maintaining surgical integrity. It offers a middle path between standard and extended cholecystectomy, reducing the chance of over- or under-treatment. This approach ensures patient safety, minimizes the need for conversion to open surgery, and preserves the tumour-tissue interface. CONCLUSION: Intraoperatively encountered suspicious gallbladder wall thickening can be effectively managed with laparoscopic transhepatic needle decompression and modified cystic plate cholecystectomy.

Clinical presentation of calmodulin mutations: the International Calmodulinopathy Registry.

AIMS: Calmodulinopathy due to mutations in any of the three CALM genes (CALM1-3) causes life-threatening arrhythmia syndromes, especially in young individuals. The International Calmodulinopathy Registry (ICalmR) aims to define and link the increasing complexity of the clinical presentation to the underlying molecular mechanisms. METHODS AND RESULTS: The ICalmR is an international, collaborative, observational study, assembling and analysing clinical and genetic data on CALM-positive patients. The ICalmR has enrolled 140 subjects (median age 10.8 years [interquartile range 5-19]), 97 index cases and 43 family members. CALM-LQTS and CALM-CPVT are the prevalent phenotypes. Primary neurological manifestations, unrelated to post-anoxic sequelae, manifested in 20 patients. Calmodulinopathy remains associated with a high arrhythmic event rate (symptomatic patients, n = 103, 74%). However, compared with the original 2019 cohort, there was a reduced frequency and severity of all cardiac events (61% vs. 85%; P = .001) and sudden death (9% vs. 27%; P = .008). Data on therapy do not allow definitive recommendations. Cardiac structural abnormalities, either cardiomyopathy or congenital heart defects, are present in 30% of patients, mainly CALM-LQTS, and lethal cases of heart failure have occurred. The number of familial cases and of families with strikingly different phenotypes is increasing. CONCLUSION: Calmodulinopathy has pleiotropic presentations, from channelopathy to syndromic forms. Clinical severity ranges from the early onset of life-threatening arrhythmias to the absence of symptoms, and the percentage of milder and familial forms is increasing. There are no hard data to guide therapy, and current management includes pharmacological and surgical antiadrenergic interventions with sodium channel blockers often accompanied by an implantable cardioverter-defibrillator.

Phosphorylation-mediated regulation of the Bacillus anthracis phosphoglycerate mutase by the Ser/Thr protein kinase PrkC.

Bacillus anthracis Ser/Thr protein kinase PrkC is necessary for phenotypic memory and spore germination, and the loss of PrkC-dependent phosphorylation events affect the spore development. During sporulation, Bacillus sp. can store 3-Phosphoglycerate (3-PGA) that will be required at the onset of germination when ATP will be necessary. The Phosphoglycerate mutase (Pgm) catalyzes the isomerization of 2-PGA and 3-PGA and is important for spore germination as a key metabolic enzyme that maintains 3-PGA pool at later events. Therefore, regulation of Pgm is important for an efficient spore germination process and metabolic switching. While the increased expression of Pgm in B. anthracis decreases spore germination efficiency, it remains unexplored if PrkC could directly influence Pgm activity. Here, we report the phosphorylation and regulation of Pgm by PrkC and its impact on Pgm stability and catalytic activity. Mass spectrometry revealed Pgm phosphorylation on seven threonine residues. In silico mutational analysis highlighted the role of Thr459 residue towards metal and substrate binding. Altogether, we demonstrated that PrkC-mediated Pgm phosphorylation negatively regulates its activity that is essential to maintain Pgm in its apo-like isoform before germination. This study advances the role of Pgm regulation that represents an important switch for B. anthracis resumption of metabolism and spore germination.

Cu(I)-Catalyzed Click Chemistry in Glycoscience and Their Diverse Applications.

Copper(I)-catalyzed 1,3-dipolar cycloaddition between organic azides and terminal alkynes, commonly known as CuAAC or click chemistry, has been identified as one of the most successful, versatile, reliable, and modular strategies for the rapid and regioselective construction of 1,4-disubstituted 1,2,3-triazoles as diversely functionalized molecules. Carbohydrates, an integral part of living cells, have several fascinating features, including their structural diversity, biocompatibility, bioavailability, hydrophilicity, and superior ADME properties with minimal toxicity, which support increased demand to explore them as versatile scaffolds for easy access to diverse glycohybrids and well-defined glycoconjugates for complete chemical, biochemical, and pharmacological investigations. This review highlights the successful development of CuAAC or click chemistry in emerging areas of glycoscience, including the synthesis of triazole appended carbohydrate-containing molecular architectures (mainly glycohybrids, glycoconjugates, glycopolymers, glycopeptides, glycoproteins, glycolipids, glycoclusters, and glycodendrimers through regioselective triazole forming modular and bio-orthogonal coupling protocols). It discusses the widespread applications of these glycoproducts as enzyme inhibitors in drug discovery and development, sensing, gelation, chelation, glycosylation, and catalysis. This review also covers the impact of click chemistry and provides future perspectives on its role in various emerging disciplines of science and technology.

Design, Synthesis, and Docking Study of Quinine-9-Triazolyl Conjugates.

To develop a better chemotherapeutically potential candidate for lung cancer treatment and cure with repurposed motifs, quinine has been linked with biocompatible CuAAC-inspired regioselective 1,2,3-triazole linker and a series of ten novel 1,2,3-triazolyl-9-quinine conjugates have been developed by utilizing click conjugation of glycosyl ether alkynes with 9-epi-9-azido-9-deoxy-quinine under standard click conditions. In parallel, the docking study indicated that the resulting conjugates have an overall appreciable interaction with ALK-5 macromolecules. Moreover, the mannose-triazolyl conjugate exhibited the highest binding interactions of -7.6 kcal/mol with H-bond interaction with the targeted macromolecular system and indicate the hope for future trials for anti-lung cancer candidates.

Evaluating the efficacy of stool sample on Xpert MTB/RIF Ultra and its comparison with other sample types by meta-analysis for TB diagnostics.

Precise and timely detection of tuberculosis (TB) is crucial to reduce transmission. This study aims to assess the accuracy of Xpert MTB/RIF Ultra on stool samples and systematically review the performance of Xpert MTB/RIF Ultra with different sample types by meta-analysis. Stool samples of smear-negative pulmonary TB (PTB), cervical lymph node TB, and abdominal TB patients were tested on the Xpert MTB/RIF Ultra system. Meta-analysis was performed on a set of 44 studies. Data were grouped by sample type, and the pooled sensitivity and specificity of Xpert MTB/RIF Ultra were calculated. The sensitivity of Xpert MTB/RIF Ultra with stool samples was 100% for smear-negative PTB, 27.27% for cervical lymph node TB, and 50% for abdominal TB patients, with 100% specificity for all included TB groups. The summary estimate for all PTB samples showed 84.2% sensitivity and 94.5% specificity, and EPTB samples showed 88.6% sensitivity and 96.4% specificity. Among all sample types included in our meta-analysis, urine showed the best performance for EPTB diagnosis. This pilot study supports the use of stool as an alternative non-invasive sample on Xpert MTB/RIF Ultra for rapid testing, suitable for both PTB and EPTB diagnosis.

Contact force ablation of accessory pathways in pediatric patients.

INTRODUCTION: Contact force (CF) catheters provide feedback confirming adequate tissue contact for optimal lesion size and minimal complications. CF ablation catheters have resulted in decreased procedure times and improved outcomes for ablation of atrial fibrillation in adults. There is limited data evaluating CF use for accessory pathway (AP) ablation or in pediatric patients. The aim of our study was to compare a cohort who underwent AP ablation with a CF catheter to historical controls, evaluating for differences in procedure times, number of lesions, and outcomes. METHODS: A retrospective chart review of CF ablation cases at Children's Wisconsin performed between June 2015 to April 2018 was compared to a historical control cohort of traditional radiofrequency (RF) ablations between June 2012 and June 2015. 43 patients with APs underwent 49 CF ablation procedures (18 males, 13.6 ± 3 years old) and a control cohort consisted of 77 procedures in 69 patients (38 males, 12.4 ± 4 years). RESULTS: The groups did not differ significantly on procedure time (CF 2.01 ± 0.48 h, control 1.53 ± 0.48 h, p = .37), or total lesions administered (CF and control 7 ± 6 lesions, p = .89). CF cases showed a trend toward improvement in acute success (98% CF, 90% controls, p = .15) though with increased recurrence compared to controls (13% CF, 4.3% controls, p = .16), neither being statistically significant. CONCLUSION: Our study suggests that ablation outcomes using CF are comparable to traditional RF ablation in pediatric patients with APs.

Glycosyl Triazole Ligand for Temperature-Dependent Competitive Reactions of Cu-Catalyzed Sonogashira Coupling and Glaser Coupling.

Glycosyl triazoles have been introduced as efficient ligands for the Cu-catalyzed Sonogashira reaction to overcome the challenges of sideways homocoupling reactions in Cu catalysis in this reaction. The atmospheric oxygen in a sealed tube did not affect the coupling, and no need of complete exclusion of oxygen was experienced in the presence of glycohybrid triazole ligand L3. High product yields were obtained at 130 °C for a variety of substrates including aliphatic and aromatic terminal alkynes and differently substituted aromatic halides including 9-bromo noscapine. In contrast, at room temperature, a very low loading of the L3-Cu catalytic system could produce excellent yields in Glaser coupling including homocoupling and heterocoupling of a variety of aliphatic and aromatic alkynes.

Synthesis of a Series of a Few Hydrosulfide Complexes of Cu(I). A µ3-SH-Bridged Rare Cubane-like Tetramer Showing Efficient Catalytic Activity toward Azide-Alkyne Cycloaddition.

A cubane-like tetranuclear hydrosulfido complex of Cu(I), [Cu4(SH)4(PPh3)4] (1), has been synthesized by the reaction of Cu(NO3)2·3H2O, NaSCOPh, and Cu(PPh3)2NO3 and characterized structurally. Complex 1 represents the first example of crystallographically characterized µ3-SH-bridged cubanoid hydrosulfide. By direct reactions of [(PPh3)2Cu(NO3)] and NaSH, neutral hydrosulfide complexes [Cu(SH)(PPh3)2]·C6H6 (2), [Cu2(SH)2(PPh3)3] (3), and [Cu2(SH)2(PPh3)4] (4) have also been synthesized and structurally characterized. Complex 2 is monomeric with a terminal hydrosulfide ligand. The other two, 3 and 4, are µ2-SH-bridged unsymmetrical and symmetrical dinuclear complexes, respectively. In the symmetric one (4), both Cu(I) ions are tetrahedrally coordinated while in the unsymmetric one (3), one Cu(I) ion is tetrahedral and the other one has a trigonal-planar coordination geometry. The catalytic activity of a hydrosulfido complex in a "click" azide-alkyne cycloaddition reaction has been explored for the first time, and complex 1 is found to be an efficient catalyst for the regioselective synthesis of glycoconjugate triazoles.

Gut microbiome of endangered Tor putitora (Ham.) as a reservoir of antibiotic resistance genes and pathogens associated with fish health.

BACKGROUND: Tor putitora, the largest freshwater fish of the Indian subcontinent, is an endangered species. Several factors have been attributed towards its continuous population decrease, but very little is known about the gut microbiome of this fish. Also, the fish gut microbiome serves as a reservoir of virulence factors and antibiotic resistance determinants. Therefore, the shotgun metagenomic approach was employed to investigate the taxonomic composition and functional potential of microbial communities present in the gut of Tor putitora, as well as the detection of virulence and antibiotic resistance genes in the microbiome. RESULTS: The analysis of bacterial diversity showed that Proteobacteria was predominant phylum, followed by Chloroflexi, Bacteroidetes, and Actinobacteria. Within Proteobacteria, Aeromonas and Caulobacter were chiefly present; also, Klebsiella, Escherichia, and plant symbionts were noticeably detected. Functional characterization of gut microbes endowed the virulence determinants, while surveillance of antibiotic resistance genes showed the dominance of ß-lactamase variants. The antibiotic-resistant Klebsiella pneumoniae and Escherichia coli pathovars were also detected. Microbial genome reconstruction and comparative genomics confirmed the presence of Aeromonads, the predominant fish pathogens. CONCLUSIONS: Gut microbiome of endangered Tor putitora consisted of both commensals and opportunistic pathogens, implying that factors adversely affecting the non-pathogenic population would allow colonization and proliferation of pathogens causing diseased state in asymptomatic Tor putitora. The presence of virulence factors and antibiotic resistance genes suggested the potential risk of dissemination to other bacteria due to horizontal gene transfer, thereby posing a threat to fish and human health. The preservation of healthy gut microflora and limited use of antibiotics are some of the prerequisites for the conservation of this imperilled species.

Traumatic Rupture of Jejunal Burkitt's Lymphoma with Intestinal Transection.

Burkitt's lymphoma (BL) is an aggressive non-Hodgkin lymphoma.[1] BL of the small intestine, presenting as a surgical emergency needing emergency laparotomy, is an uncommon presentation of this tumor. We present a case of BL presenting as perforation peritonitis after blunt trauma abdomen.

Comparison of DNA Extraction Methods for Optimal Recovery of Metagenomic DNA from Human and Environmental Samples.

Metagenomics is the study of gene pool of an entire community in a particular niche. This provides valuable information about the functionality of host-microbe interaction in a biological ecosystem. Efficient metagenomic DNA extraction is a critical pre-requisite for a successful sequencing run in a metagenomic study. Although isolation of human stool metagenomic DNA is fairly standardized, the same protocol does not work as efficiently in fecal DNA from other organisms. In this study, we report a comparison of manual and commercial DNA extraction methods for diverse samples such as human stool, fish gut and soil. Fishes are known to have variable microbial diversity based on their food habits, so the study included two different varieties of fishes. A modified protocol for effective isolation of metagenomic DNA from human milk samples is also reported, highlighting critical precautions. Recent studies have emphasized the importance of studying functionality of human milk metagenome to understand its influence on infants' health. While manual method works well with most samples and therefore can be a method of choice for testing new samples, broad-range commercial kit offers advantage of high purity and quality. DNA extraction of different samples would go a long way in unraveling the unexplored association between microbes and host in a biological system.

Gut microbiome contributes to impairment of immunity in pulmonary tuberculosis patients by alteration of butyrate and propionate producers.

Tuberculosis (TB) is primarily associated with decline in immune health status. As gut microbiome (GM) is implicated in the regulation of host immunity and metabolism, here we investigate GM alteration in TB patients by 16S rRNA gene and whole-genome shotgun sequencing. The study group constituted of patients with pulmonary TB and their healthy household contacts as controls (HCs). Significant alteration of microbial taxonomic and functional capacity was observed in patients with active TB as compared to the HCs. We observed that Prevotella and Bifidobacterium abundance were associated with HCs, whereas butyrate and propionate-producing bacteria like Faecalibacterium, Roseburia, Eubacterium and Phascolarctobacterium were significantly enriched in TB patients. Functional analysis showed reduced biosynthesis of vitamins and amino acids in favour of enriched metabolism of butyrate and propionate in TB subjects. The TB subjects were also investigated during the course of treatment, to analyse the variation of GM. Although perturbation in microbial composition was still evident after a month's administration of anti-TB drugs, significant changes were observed in metagenome gene pool that pointed towards recovery in functional capacity. Therefore, the findings from this pilot study suggest that microbial dysbiosis may contribute to pathophysiology of TB by enhancing the anti-inflammatory milieu in the host.

Cu-Catalyzed Click Reaction in Carbohydrate Chemistry.

Cu(I)-catalyzed azide-alkyne 1,3-dipolar cycloaddition (CuAAC), popularly known as the "click reaction", serves as the most potent and highly dependable tool for facile construction of simple to complex architectures at the molecular level. Click-knitted threads of two exclusively different molecular entities have created some really interesting structures for more than 15 years with a broad spectrum of applicability, including in the fascinating fields of synthetic chemistry, medicinal science, biochemistry, pharmacology, material science, and catalysis. The unique properties of the carbohydrate moiety and the advantages of highly chemo- and regioselective click chemistry, such as mild reaction conditions, efficient performance with a wide range of solvents, and compatibility with different functionalities, together produce miraculous neoglycoconjugates and neoglycopolymers with various synthetic, biological, and pharmaceutical applications. In this review we highlight the successful advancement of Cu(I)-catalyzed click chemistry in glycoscience and its applications as well as future scope in different streams of applied sciences.

Effect of altered ambient temperature through shelter modifications on physiological indicators of Malpura lambs reared in semi-arid region during winter.

Microclimatic factors are of crucial aspect for the welfare of animals. Therefore, a study was conducted to assess the effect of altered ambient temperature through shelter modifications on physiological indicators of Malpura lambs reared in the semi-arid region during winter. Twenty-one Malpura lambs of 3-5 week age and average body weight 9.97 ±â€¯0.51 kg were used in the present study. The lambs were divided into three groups (eg. G1, G2, and G3) and were kept in the different microenvironment by manipulation of shelter design. The G1 lambs were maintained at lower minimum temperature (8.59 ±â€¯0.71 °C) in asbestos roofed shed, while G2 lambs were maintained at higher minimum temperature (14.59 ±â€¯0.54 °C) in local handmade bamboo dome structure, and G3 lambs were kept at a medium minimum temperature (11.84 ±â€¯0.64 °C) in thermocol insulated roofed shed from evening 18:30 h to morning 07:00 h. The study was carried out for one month between January and February. The parameters studied were physiological response (respiration rate, pulse rate, rectal temperature), skin temperature, blood metabolites and endocrine profile. The data were analyzed by general linear models. Higher average daily weight gain was recorded in the lambs kept in higher minimum temperature groups (20.54% higher in G2 and 24.68% higher in G3) as compared to G1 lambs. Microenvironment manipulation had no significant (P > 0.05) effect on most of the physiological response and skin temperature except morning respiration rate within low-temperature range. The present study reveals that Hb, PCV, T3, and cortisol level were significantly (P < 0.05) influenced by microenvironment manipulation. The results of the study indicated that altered ambient temperature through altered shelter design of housing for raising of lambs in the semi-arid tropical region may support animal welfare during chilling nights of the winter.

Transplacental treatment of fetal tachycardia: A systematic review and meta-analysis.

OBJECTIVE: Multiple transplacental medications can be used to treat fetal tachycardia. We sought to perform a systematic review and meta-analysis to determine whether digoxin, flecainide, or sotalol was the most efficacious therapy for converting fetal tachycardia to sinus rhythm. METHOD: We performed a systematic review and meta-analysis to compare digoxin, flecainide, or sotalol as first-line therapy for fetal tachycardia. Studies were identified by a search of PubMed (Medline), Web of Science, and Scopus. RESULTS: There were 21 studies included. Flecainide (OR: 1.4, 95% CI: 1.1-2.0, I2  = 60%, P = 0.03) and sotalol (OR:1.4, 95% CI:1.1-2.0, I2  = 30%, P = 0.02) were superior to digoxin for conversion of fetal tachycardia to sinus rhythm. In those with hydrops, the benefit over digoxin was more notable for both flecainide (OR: 5.0, 95% CI: 2.5-10.0, I2  = 0%, P < 0.001) and sotalol (OR: 2.5, 95% CI: 1.7-5.0, I2  = 0%, P < 0.001). When limited to atrioventricular reentrant tachycardia, flecainide was superior to digoxin (OR:1.7, 95% CI:1.1-3.3, I2  = 62%, P = 0.03) and sotalol (OR:1.3, 95% CI:1.1-1.7, I2  = 0%, P = 0.01). CONCLUSION: Digoxin should not be first-line therapy for fetal tachycardia, particularly in the presence of hydrops fetalis. Flecainide should be the first-line therapy of choice in atrioventricular reentrant tachycardia. Further study may identify further sub-populations responding differently.

Cyanobacteria as efficient producers of mycosporine-like amino acids.

Mycosporine-like amino acids are the most common group of transparent ultraviolet radiation absorbing intracellular secondary metabolites. These molecules absorb light in the range of ultraviolet-A and -B with a maximum absorbance between 310 and 362 nm. Cyanobacteria might have faced the most deleterious ultraviolet radiation, which leads to an evolution of ultraviolet protecting mycosporine-like amino acids for efficient selection in the environment. In the last 30 years, scientists have investigated various cyanobacteria for novel mycosporine-like amino acids, applying different induction techniques. This review organizes all the cyanobacterial groups that produce various mycosporine-like amino acids. We found out that cyanobacteria belonging to orders Synechococcales, Chroococcales, Oscillatoriales, and Nostocales are frequently studied for the presence of mycosporine-like amino acids, while orders Gloeobacterales, Spirulinales, Pleurocapsales, and Chroococcidiopsidales are still need to be investigated. Nostoc and Anabaena strains are major studied genus for the mycosporine-like amino acids production. Hence, this review will give further insight to the readers about potential mycosporine-like amino acid producing cyanobacterial groups in future investigations.

Effect of protection against hot climate on growth performance, physiological response and endocrine profile of growing lambs under semi-arid tropical environment.

In the hot semi-arid tropical region, extreme summer is a major constraint in sheep production. The growth performance of growing lambs is impaired during the summer. Therefore, the present study was conducted to assess the effect of protection against hot climate on growth performance, physiological response, and endocrine profile of growing lambs under semi-arid tropical environment. All the data in the experiment were presented as mean ± SE. Thirty Malpura lambs with the age of 122.7 ± 6.05 days and body weight of 19.52 ± 0.42 kg were allotted into three groups, viz. G1 (control, lambs kept in open area under tree shade), G2 (lambs kept in conventional asbestos-roofed shed), and G3 (lambs kept in designed shed). The allotment was based on their initial body weight so that the mean body weight of each group was similar. In all three types of protection, lambs were provided with sufficient space to move and social interaction. In asbestos-roofed shed (G2), all the four sides from ground to the roof were fenced with strong galvanized iron chain link. But in G3, all the four sides were constructed in a manner that there was 0.13 m air space between inner and outer solid brick columns of the wall up to 1.37 m height, and rest up to the roof was fenced with bamboo splint net. The air space between the two columns of the wall was filled with sand, and it was kept in moist condition by continuous water drips which provide extra evaporative cooling. The designed shed was basically constructed with bamboo. Tree shade was assured under the natural shades of large trees. The shaded area was protected by wire fences. The experiment was conducted for 45 days during very high temperature (May-June). The lambs were provided with ad libitum green fodder, dry roughage, 300 g concentrate, and ad libitum drinking water. The respiration rate at morning and afternoon, pulse rate at morning and afternoon and rectal temperature at afternoon was significantly (P < 0.05) lower in lambs of G3 as compared to other groups. The final body weight did not differ significantly between the groups, but average daily gain (g/day) was higher in G3 (150.06 ± 11.13) as compared to the G1 (109.69 ± 18.10). The feed conversion rate (FCR) was significantly (P < 0.05) better in G3 (5.49 ± 0.08) as compared to G1 (7.65 ± 0.08) and G2 (6.60 ± 0.08). The hemoglobin level was significantly (P < 0.05) higher in G1. The endocrine profile did not vary significantly (P > 0.05) among the groups, but insulin-like growth factor-1 (IGF-1) was higher in G3. It can be concluded from this study the lambs provided with better protection during summer remained in more comfortable condition, showed better FCR, and although not statistically significant showed better growth performance.

The Impact of Aortic Valve Replacement on Left Ventricular Remodeling in Children.

There are scant data in pediatrics on the optimal timing for aortic valve repair (AVR). This study assesses the midterm response to AVR and possible predictors of poor outcome. From 2001 to 2006, 41 patients had greater than 3-month follow-up after AVR for aortic insufficiency, aortic stenosis, or both. Pre-, peri-, and post-operative data were collected, including demographics and clinical symptoms. Two reviewers measured echocardiographic parameters from the pre-operative and latest follow-up echocardiograms. Ventricular dimensions were indexed to body surface area (z-score). Median age at AVR was 13 years with 83 % having a Ross operation. The average left ventricular end-diastolic dimension pre-op, z-score of +1.3, significantly decreased at last follow-up to a mean z-score of -0.1 (p < 0.001). Similarly the indexed LV mass decreased from +3.9 to +0.5 (p < 0.001). There was no significant correlation between the presence of pre-op symptoms and the presence of post-op LV dilatation, hypertrophy, or dysfunction. In the subset of patients (7/41) with persistent LV dysfunction at last follow-up, there was a significant correlation with pre-op LV dilatation as assessed by both LVEDD (p = 0.02) and LVESD (p = 0.05). Children demonstrate significant reverse remodeling after AVR. Pre-op LV dilatation may predict patients with persistent LV dysfunction post-AVR. Symptoms are less useful in children, suggesting the need for more objective data for functional assessment.