Aortic dissection late after repair of tetralogy of Fallot

Kim, Woong-Han; Seo, Jeong‐Wook; Kim, Soojin; Song, Jinyoung; Lee, Jae-Young; Na, Chan-Young

doi:10.1016/j.ijcard.2004.03.026

Cited by 94 publications

(58 citation statements)

References 3 publications

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“…In Mayo Clinic series, the largest aortic root measured was 8.5 cm in diameter without dissection. The literature documents two isolated reports of aortic dissection with aortic root diameters of 6.45 cm [39] and 6.1 cm [40]. In our study the largest aortic root measured was 5.6 cm in diameter without dissection at the level of sinus of valsalva in uncorrected TOF patients.…”

Section: Aortic Root Dilatation In Unrepaired Tetralogy Of Fallotsupporting

confidence: 52%

Predictors for Dilated Aorta in Repaired and Unrepaired Tetralogy of Fallot

Meguid¹,

Mahmoud²,

Mohammad³

2015

WJCD

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Aortic root pathology has been described in patients with Tetralogy of Fallot, although the most common reason for repeat surgery in the adult after TOF repair relates to problems in the right ventricular outflow tract, the aortic root is often forgotten. Objective: We sought to determine those patients with known Fallot tetrallogy at risk for progressive dilatation of the thoracic aorta and explore the common predictors present in this patient group. Methods and Results: A multicenter observational study which enrolled 100 patients (50 surgically repaired and 50 before surgical repair of TOF) with standardized reassessment of echocardiographic parameters and multislice CT angiography of the heart and great vessels data. The data were reviewed and analyzed according to the demographic, morphological, surgical and clinical details. We used standard nomograms and Z score for aortic root dimensions at the level of aortic annulus, sino- 23422% of patients after intra-cardiac repair of TOF. Older age at repair, long shunt to repair interval and residual ventricular septal defect are the most common variables associated with aortopathy and aortic regurgitation in such group of patients. The second important finding is the occurrence of aortic root dilatation in 70% of patients before surgical repair of TOF; whereas male sex and TOF with pulmonary atresia appeared to be the most common variables associated with aortopathy and aortic regurgitation in this group of patients.

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Section: Aortic Root Dilatation In Unrepaired Tetralogy Of Fallotsupporting

confidence: 52%

Predictors for Dilated Aorta in Repaired and Unrepaired Tetralogy of Fallot

Meguid¹,

Mahmoud²,

Mohammad³

2015

WJCD

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“…9,10 To our knowledge, this Alliance for Adult Research in Congenital Cardiology study is the largest to assess the prevalence and predictors of aortic root dilatation in patients with TOF. When an absolute threshold of 40 mm was used to define a dilated aortic root, a prevalence of 28.9% was observed.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11] All cases occurred in young men with severely dilated ascending aortas (93, 70.5, and 70 mm). Two had undergone TOF repair later in life (6 and 21 years of age) and experienced major gaps in care.…”

Section: Aortic Dissectionmentioning

confidence: 99%

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Aortic Root Dilatation in Adults with Surgically Repaired Tetralogy of Fallot

et al. 2013

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Background— Although aortic root pathology has been described in patients with tetralogy of Fallot, the scope of the problem remains poorly defined. We sought to determine the prevalence and predictors of aortic root dilatation in adults with repaired tetralogy of Fallot. Methods and Results— A multicenter cross-sectional study was conducted with standardized reassessment of echocardiographic parameters in 474 adults (≥18 years) with surgically repaired tetralogy of Fallot or pulmonary atresia with ventricular septal defect. The aortic root was measured in a parasternal long-axis view, in diastole, at the level of the sinus of Valsalva. Prevalence and predictors of an absolute diameter ≥40 mm and of an observed-to-expected ratio >1.5 were assessed. The aortic root dimension was ≥40 mm in 28.9% (95% confidence interval, 26.9%–30.9%). In multivariate analyses, the only independently associated factor was male sex (odds ratio, 4.48; 95% confidence interval, 1.55–12.89; P =0.006). The prevalence of an observed-to-expected aortic root dimension ratio >1.5 was 6.6% (95% confidence interval, 5.3%–7.9%). It was associated with pulmonary atresia and moderate or severe aortic regurgitation in univariate analyses, but no independent predictor was identified. The side of the aortic arch was not associated with aortic root dimension. The prevalence of moderate or severe aortic regurgitation was 3.5% (95% confidence interval, 2.7%–4.2%). Conclusions— Although nearly one third of adults with repaired tetralogy of Fallot have an aortic root diameter ≥40 mm, the prevalence of a dilated aortic root, when defined by an indexed ratio of observed-to-expected values, is low. Similarly, moderate or severe aortic regurgitation is uncommon.

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“…[1][2][3][4][5][6][7] Limited longitudinal data from adult patients suggest that the dilatation is progressive despite surgery, 1 which may result in significant aortic regurgitation and necessitate prosthetic valve replacement. 2 Niwa and colleagues 1 recently reported that 15% of their cohort of 216 adult patients after repair of ToF had aortic root dilatation, with dilatation increasing at a rate of 17 mm/year in this subgroup.…”

Section: Discussionmentioning

confidence: 99%

Central and peripheral arterial stiffness in patients after surgical repair of tetralogy of Fallot: implications for aortic root dilatation

Cheung

Wong

2006

Heart

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Objectives: To test the hypotheses that (1) the central conduit arteries stiffen preferentially over the peripheral conduit arteries in patients with repaired tetralogy of Fallot (ToF); and (2) central arterial stiffening is related to aortic root dilatation. Design and patients: Heart-femoral pulse wave velocity (PWV), femoral-ankle PWV, carotid augmentation index and body surface area-adjusted aortic sinotubular dimension were determined in 31 children after ToF repair and compared with those in 31 age-matched controls after left-to-right shunt repair. In addition, the PWVs and augmentation index were related to the sinotubular junction dimension. Conclusions:The aorta stiffens in patients with repaired ToF, which may contribute to progressive dilatation of the aortic root in the long term.

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Aortic dissection late after repair of tetralogy of Fallot

Cited by 94 publications

References 3 publications

Predictors for Dilated Aorta in Repaired and Unrepaired Tetralogy of Fallot

Predictors for Dilated Aorta in Repaired and Unrepaired Tetralogy of Fallot

Aortic Root Dilatation in Adults with Surgically Repaired Tetralogy of Fallot

Central and peripheral arterial stiffness in patients after surgical repair of tetralogy of Fallot: implications for aortic root dilatation

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