Pediatric Cardiology

, Volume 34, Issue 4, pp 809–816

Tetralogy of Fallot and Aortic Root Dilation: A Long-Term Outlook

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

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.

Keywords

Tetralogy of Fallot Congenital heart disease Aorta Aneurysm Dissection 

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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Christian D. Nagy
    • 7
  • Diane E. Alejo
    • 3
  • Mary C. Corretti
    • 2
  • William J. Ravekes
    • 1
  • Jane E. Crosson
    • 1
  • Philip J. Spevak
    • 1
  • Richard Ringel
    • 1
  • Kathryn A. Carson
    • 6
  • Sara Khalil
    • 5
  • Harry C. Dietz
    • 4
  • Duke E. Cameron
    • 3
  • Luca A. Vricella
    • 3
  • Thomas A. Traill
    • 2
  • Kathryn W. Holmes
    • 1
  1. 1.Division of Pediatric CardiologyThe Johns Hopkins Hospital, The Johns Hopkins Medical InstitutionsBaltimoreUSA
  2. 2.Division of Adult CardiologyThe Johns Hopkins Medical InstitutionsBaltimoreUSA
  3. 3.Division of Cardiac SurgeryThe Johns Hopkins Medical InstitutionsBaltimoreUSA
  4. 4.Institute of Genetic Medicine and Howard Hughes Medical Institute, The Johns Hopkins Medical InstitutionsBaltimoreUSA
  5. 5.The Johns Hopkins School of MedicineThe Johns Hopkins Medical InstitutionsBaltimoreUSA
  6. 6.Department of Epidemiology, Bloomberg School of Public HealthThe Johns Hopkins Medical InstitutionsBaltimoreUSA
  7. 7.Division of CardiologyTufts Medical CenterBostonUSA

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