Tetralogy of Fallot and aortic root dilation: a long-term outlook.
Dilation of the sinus of Valsalva (SoV) has been increasingly observed after repaired tetralogy of Fallot (TOF). We estimate the prevalence of SoV dilation in adults with repaired TOF and analyze possible factors related to aortic disease. Adults with TOF [n = 109, median age 33.2 years (range 18.1 to 69.5)] evaluated at Johns Hopkins Hospital from 2001 to 2009 were reviewed in an observational retrospective cohort study. Median follow-up was 27.3 (range 0.1-48.8) years. SoV dilation was defined as >95 % confidence interval adjusted for age and body surface area (z-score > 2). The prevalence of SoV dilation was 51 % compared with that of a normal population with a mean z-score of 2.03. Maximal aortic diameters were ≥ 4 cm in 39 % (42 of 109), ≥ 4.5 cm in 21 % (23 of 109), ≥ 5 cm in 8 % (9 of 109), and ≥ 5.5 cm in 2 % (2 of 109). There was no aortic dissection or death due contributable to aortic disease. Aortic valve replacement was performed in 1.8 % and aortic root or ascending aorta (AA) replacement surgery in 2.8 % of patients. By multivariate logistic regression analysis, aortic regurgitation (AR) [odds ratio (OR) = 3.09, p = 0.005], residual ventricular septal defect (VSD) (OR = 4.14, p < 0.02), and TOF with pulmonary atresia (TOF/PA) (OR = 6.75, p = 0.03) were associated with increased odds of dilated aortic root. SoV dilation after TOF repair is common and persists with aging. AR, residual VSD, and TOF/PA are associated with increased odds of dilation. AA evaluation beyond the SoV is important. Indexed values are imperative to avoid bias on the basis of age and body surface area.
Division of Cardiology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA.
Christian D
CD
Nagy
Diane E
DE
Alejo
Mary C
MC
Corretti
William J
WJ
Ravekes
Jane E
JE
Crosson
Philip J
PJ
Spevak
Richard
R
Ringel
Kathryn A
KA
Carson
Sara
S
Khalil
Harry C
HC
Dietz
Duke E
DE
Cameron
Luca A
LA
Vricella
Thomas A
TA
Traill
Kathryn W
KW
Holmes
D000293:Adolescent; D000328:Adult; D000368:Aged; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology*; D004108:Dilatation, Pathologic; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D015995:Prevalence; D012189:Retrospective Studies; D012850:Sinus of Valsalva / Q000473:pathology*; D013771:Tetralogy of Fallot / Q000150:complications / Q000503:physiopathology / Q000601:surgery*