title: Dilatation of the ascending aorta is associated with presence of aortic regurgitation in patients after repair of tetralogy of Fallot.
abstract: To evaluate the association between aortic morphology and elasticity with aortic regurgitation in surgically corrected of tetralogy of Fallot (TOF) patients. We retrospectively identified 72 consecutive patients with surgically corrected TOF and 27 healthy controls who underwent cardiac MRI evaluation. Velocity-encoded cine MRI was used to quantify degree of aortic regurgitation (AR) in TOF patients. Ascending aorta diameters were measured at standard levels on MRA images. Aortic pulse-wave velocity (PWV) was quantified with MRI. Morphological and functional MRI variables were compared between groups of TOF patients with and without clinically relevant AR and controls. The association between aortic morphology and elasticity with the presence of AR was evaluated using univariate and multivariate logistic regression. The majority of TOF patients had only trace AR. Nine TOF patients (12 %) had an AR fraction higher than 15 %. Indexed aorta diameter at the sinotubular junction (p = 0.007), at the RPA level (p = 0.006), and low left ventricular ejection fraction (LVEF) (p = 0.015) showed the strongest associations with the presence of at least mild AR, which persisted after controlling for age and gender. Increased ascending aorta dimension is associated with AR in patients after repair of TOF. LVEF was also low in the group of patients with relevant AR compared to those without, suggesting even mild to moderate AR may contribute to LV dysfunction in these patients. Enlarged ascending aorta may be an indication for precise quantification of regurgitant fraction with MRI, since symptomatic patients may need aortic valve repair when moderate regurgitation is present.
authors.affiliation: UCSF, San Francisco, CA, USA. Karen.Ordovas@ucsf.edu.
authors.forename: Karen Gomes
authors.initials: KG
authors.lastname: Ordovas
authors.affiliation: UCSF, San Francisco, CA, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Keedy
authors.affiliation: UCSF, San Francisco, CA, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Naeger
authors.affiliation: UCSF, San Francisco, CA, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kallianos
authors.affiliation: UCSF, San Francisco, CA, USA.
authors.forename: Elyse
authors.initials: E
authors.lastname: Foster
authors.affiliation: UCSF, San Francisco, CA, USA.
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.affiliation: UCSF, San Francisco, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Saloner
authors.affiliation: UCSF, San Francisco, CA, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hope
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016009:Chi-Square Distribution; D002648:Child; D003430:Cross-Sectional Studies; D004108:Dilatation, Pathologic; D004548:Elasticity; D005260:Female; D006801:Humans; D016015:Logistic Models; D018810:Magnetic Resonance Angiography; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D063177:Pulse Wave Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012495:San Francisco; D013318:Stroke Volume; D013771:Tetralogy of Fallot / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D059289:Vascular Stiffness; D016277:Ventricular Function, Left; D055815:Young Adult
keywords: Aortic dilatation; Aortic insufficiency; MRI; Tetralogy of Fallot