Correlation Between Total Repair Timing and Late Aortic Root Dilatation in Repaired Tetralogy of Fallot
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ORIGINAL ARTICLE
Correlation Between Total Repair Timing and Late Aortic Root Dilatation in Repaired Tetralogy of Fallot Hyung Tae Sim1 · Jeong‑Won Kim2 · Seong Ho Kim3 · Su‑Jin Park3 · So‑Ick Jang3 · Chang‑Ha Lee2 Received: 19 March 2020 / Accepted: 11 June 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020, corrected publication 2020
Abstract Aortic root dilatation is frequently encountered in adults with repaired Tetralogy of Fallot (TOF). The timing of total repair is known to have a significant correlation with late aortic root dilatation, but it is not well established. The objective of this study was to investigate the risk factors and correlation with timing of total repair for aortic root dilatation in adults with repaired TOF. An observational retrospective cohort study was conducted in 314 adults (≥ 18 years) with repaired TOF. Aortic root dilatation was defined when the absolute diameter of Sinus of Valsalva (SoV) was over 40 mm. SoV was measured by echocardiography in 110 patients, computed tomography angiography in 168 patients, and magnetic resonance image in 36 patients. Aortic root dilatation was observed in 65 patients (20.7%). Among them, 3 patients underwent Bentall operation due to acute aortic dissection or aortic root aneurysm. On multivariate logistic regression analysis, age at total repair was a significant risk factor for late aortic root dilatation (OR = 3.14; 95% CI 1.62–6.08; p = 0.001) and the cutoff value of age was 1.9 years. However, late aortic root dilatation was also observed in 10% of patients (10/91) who operated before 1 year of age. Late total repair was a significant risk factor for late aortic root dilatation in repaired TOF. However, early total repair did not always prevent late aortic root dilatation. These results suggest that congenital aortic pathology may also be a pos‑ sible cause of aortic root dilatation along with longstanding hemodynamic stress. Keywords Tetralogy of Fallot · Aorta · Sinus of Valsalva · Dilatation
Introduction Aortic root dilatation is a known clinical feature of unre‑ paired Tetralogy of Fallot (TOF) [1, 2]. Hemodynamic stress on the aortic wall before repair may play a role in progres‑ sive aortic dilatation [1]. Increased and altered flow through the overriding aorta and uneven sharing of conotruncal tis‑ sue between the aorta and pulmonary artery may contribute to aortic root dilatation [3]. Aortic root dilatation is also * Chang‑Ha Lee [email protected] 1
Department of Thoracic and Cardiovascular Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
2
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, 28, Hohyeon‑ro 489 Beon‑gil, Sosa‑gu, Bucheon, Gyeonggi‑do 422‑711, Republic of Korea
3
Department of Pediatric Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
observed in adult patients late after repair of TOF [2–6]. This may result from another mechanism of intrinsic aor‑ topa
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