Tetralogy of fallot and aortic root dilation: A long-term outlook

Christian D. Nagy, Diane E. Alejo, Mary Corretti, William Ravekes, Jane Crosson, Philip J Spevak, Richard Ringel, Kathryn Anne Carson, Sara Khalil, Harry C Dietz, Duke E. Cameron, Luca Vricella, Thomas A Traill, Kathryn W. Holmes

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)809-816
Number of pages8
JournalPediatric Cardiology
Volume34
Issue number4
DOIs
StatePublished - Apr 2013

Fingerprint

Sinus of Valsalva
Tetralogy of Fallot
Dilatation
Aortic Diseases
Aortic Valve Insufficiency
Body Surface Area
Ventricular Heart Septal Defects
Odds Ratio
Aorta
Pulmonary Atresia
Aortic Valve
Statistical Factor Analysis
Dissection
Cohort Studies
Retrospective Studies
Logistic Models
Regression Analysis
Confidence Intervals
Population

Keywords

  • Aneurysm
  • Aorta
  • Congenital heart disease
  • Dissection
  • Tetralogy of Fallot

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health

Cite this

Tetralogy of fallot and aortic root dilation : A long-term outlook. / Nagy, Christian D.; Alejo, Diane E.; Corretti, Mary; Ravekes, William; Crosson, Jane; Spevak, Philip J; Ringel, Richard; Carson, Kathryn Anne; Khalil, Sara; Dietz, Harry C; Cameron, Duke E.; Vricella, Luca; Traill, Thomas A; Holmes, Kathryn W.

In: Pediatric Cardiology, Vol. 34, No. 4, 04.2013, p. 809-816.

Research output: Contribution to journalArticle

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abstract = "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.",
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AU - Corretti, Mary

AU - Ravekes, William

AU - Crosson, Jane

AU - Spevak, Philip J

AU - Ringel, Richard

AU - Carson, Kathryn Anne

AU - Khalil, Sara

AU - Dietz, Harry C

AU - Cameron, Duke E.

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