Dimensions of the Ascending Aorta in Children and Adolescents with Repaired Tetralogy of Fallot Obtained by Cardiac Magnetic Resonance Angiography

Abstract

Introduction Dilatation of the ascending aorta is a common finding in Tetralogy of fallot (TOF). We sought to provide aortic dimensions in children and adolescents after corrected TOF obtained by contrast-enhanced cardiacmagnetic-resonance angiography (CE-CMRA) that could serve as reference values. Materials and methods We enrolled 101 children and adolescents (56 male) with a median age of 10.9 years. All patients underwent CE-CMRA imaging using a 3-dimensional spoiled gradient-echo-sequence. Aortic diameters were measured at the level of the aortic valve (AV), aortic sinus (AS), sino-tubular junction (STJ) and the ascending aorta (AA) and compared with normal values obtained from literature. Sex-specific aortic dimensions are given as percentile curves as well as z scores. Furthermore CMR volumetric and functional parameters as well as clinical and anamnestic data were analyzed to identify parameters that are associated with aortic dilatation. Results Diameters for aortic size for males were 3.6 ? 16.6*BSA 0.5 at the AV level, 7.0 ? 19.5*BSA 0.5 at the AS level, 7.0 ? 14.4*BSA 0.5 at the STJ level and 7.3 ? 15.5*BSA 0.5 at the AA level. Diameters for females were 5.8 ? 14.1*BSA 0.5 at the AV level, 7.2 ? 17.6*BSA 0.5 at the AS level, 5.2 ? 15.4*BSA 0.5 at the STJ level and 2.0 ? 17.8*BSA 0.5 at the AA level. All diameters in TOF patients were larger compared with normal values. The postoperative interval and age at examination were the only parameters associated with aortic size at all measured levels. Conclusion We provide CE-CMRA data of aortic dimensions in children and adolescents after correction of TOF. Our data might be useful for an estimation of the ''normal'' aortic size in this patient cohort and can serve as a basis for future longitudinal studies adding prognostic data.

Nomograms for Cardiovascular Magnetic Resonance Measurements in the Pediatric Age Group: To Define the Normal and the Expected Abnormal Values in Corrected/Palliated Congenital Heart Disease: A Systematic Review

“…Cardiovascular MRI is routinely used as the gold standard imaging technique for the assessment and follow‐up of specific groups of CHDs (eg, conotruncal abnormalities, right‐sided lesions, great vessels anomalies) . In such anomalies, to find measurements different from normal (eg, ascending aorta and pulmonary arteries in tetralogy of Fallot [TOF]) is almost the rule . In this setting it is important to understand not only how much a given measurement is distant from normal but also if this measure is or not similar to those of other children with the same defect.…”

“…1 In such anomalies, to find measurements different from normal (eg, ascending aorta and pulmonary arteries in tetralogy of Fallot [TOF]) is almost the rule. 1,[18][19][20][21][22][23] In this setting it is important to understand not only how much a given measurement is distant from normal but also if this measure is or not similar to those of other children with the same defect. Thus, a few recent studies [18][19][20][21][22][23] tried to derive expected abnormal cardiovascular MRI values in specific CHD with attention to repaired TOF, which is one of the most frequent indications for cardiovascular MRI examinations in the pediatric age and in young adults.…”

“…1,[18][19][20][21][22][23] In this setting it is important to understand not only how much a given measurement is distant from normal but also if this measure is or not similar to those of other children with the same defect. Thus, a few recent studies [18][19][20][21][22][23] tried to derive expected abnormal cardiovascular MRI values in specific CHD with attention to repaired TOF, which is one of the most frequent indications for cardiovascular MRI examinations in the pediatric age and in young adults. 1,[18][19][20] Shelby et al demonstrated how the variation in great arterial dimensions at any given BSA is much greater in TOF compared with normal healthy subjects and is significantly greater among men.…”

“…8 Data on neonates 2 and infants 6 were extremely limited. A few studies published disease-specific normal values in tetralogy of Fallot [18][19][20] (Table 1C).…”

“…The population of patients living with congenital heart disease (CHD) has increased with a concomitant improvement in medical and surgical therapies. Cardiovascular magnetic resonance imaging (MRI) has become an integral part of the diagnostic work‐up in children and adults with congenital and acquired cardiac diseases . Cardiovascular MRI is a noninvasive, radiation‐free modality that is complementary to echocardiography .…”