Follow-up aortic dilatation in patients with repaired tetralogy of Fallot using cardiovascular magnetic resonance

Abstract

The study sought to determine the rate of aortic expansion and correlation with somatic growth in patients with repaired tetralogy of Fallot (rTOF), and predictors for determining the annual growth rate of the aorta (Ao-AGR). Methods: Ninety-four rTOF patients (mean age 14.5 ± 4.4 years) with two cardiac magnetic resonance tests (CMR) (median duration 52 months, interquartile range, IQR 24-71) were analyzed for aortic diameter (AoD) at the annulus, the sinus of Valsalva (SoV), the sinotubular junction, and the ascending aorta (AAo), and compared with the normal limit AoD (NL-AoD) values. The median age-at-repair was 60 months (IQR 36− 84). Ao-AGR and its index (Ao-AGRI) were derived from changes of the AoD and AoD-index, respectively, divided by the duration between the two studies. Three potential predictors (baseline AoD, sex, and age-at-repair) for the progression of Ao-AGR were analyzed. Results: There was a significant larger AoD than NL-AoD (p < 0.001). Slow aortic growth was encountered in 78-85 % of patients. The Ao-AGR was slow, the median AGR ranged from 0.37 mm (IQR 0.13− 0.72) at annulus to 0.56 mm (IQR 0.22− 0.91) at AAo. There was a regression in Ao-AGRI, ranged from -1.41 mm (IQR -1.94, -0.87) at annulus to -2.36 mm (IQR -3.09, -1.63) at SoV. The three predictors were not correlated with severity of Ao-AGR. Conclusion: Most adolescents with rTOF show significant aortic dilatation. There is a slow Ao-AGR with regression of Ao-AGRI, which may suggest that the rate of aortic growth is slower than the somatic growth. There are no significant predictors of the progression of Ao-AGR.

Patterns of Aortic Dilation in Tetralogy of Fallot: An Analysis of 100 Fetal Echocardiograms Compared With Matched Controls

“…The degree of dilation and risk of aortic dissection in adults with TOF is not well understood, with mixed data on progression after initial repair. 1 , 41 , 42 , 43 , 44 Overall, in large population‐based studies, the risk of aortic dissection in conotruncal defects including TOF is exceedingly rare. 6 , 45 This low incidence makes it difficult to develop evidence‐based guidelines for surveillance or indications for prophylactic repair, which are clear and well‐defined for patients with classic aortopathies.…”

Thinking Outside the “Flow-Mediated” Box: An Analysis of Aortic Dilation in 100 Fetuses with Tetralogy of Fallot Compared to Matched Controls

“…Although aortic dilation is well-described in TOF, its degree of progression and risk of aortic dissection are less well understood, with mixed data on progressive aortic changes after initial repair 1,[33][34][35][36] . Overall, in large population-based studies, the risk of aortic dissection in conotruncal defects including TOF is exceedingly rare 37,38 .…”

The Surgical Strategy for Progressive Dilatation of Aortic Root and Aortic Regurgitation After Repaired Tetralogy of Fallot: A Case Report

“…We believe that the postoperative progressive dilatation of aortic root after rTOF is the leading cause for postoperative AR mainly associated with altered hemodynamics and inherent defects of the aortic wall. During the follow-up period, aortic dilatation has been found in most adult patients with rTOF, interestingly, however, it is concepted that as a part of normal physical process, not all aortic dilatation cause AR inevitably ( 9 ). This may be due to the dilatation of the aortic root did not involve the aortic annulus.…”