799 Aortic Root Dilatation in Adults With Surgically Repaired Tetralogy of Fallot: A Multicenter Cross-Sectional Study

Abstract

BackgroundAortic root pathology has been described in patients with tetralogy of Fallot (TOF), but the scope of the problem remains poorly defined. We sought to determine the prevalence and predictors of aortic root dilatation in adults with repaired TOF.Methods and ResultsA multicenter cross-sectional study was conducted with standardized reassessment of echocardiographic parameters in 474 adults (≥18 years) with surgically repaired TOF or pulmonary atresia with ventricular septal defect. The aortic root was measured in a parasternal long-axis echocardiographic view, at the level of the sinus of Valsalva. The prevalence and predictors of an absolute diameter ≥40 mm and of an observed to expected ratio >1.5 were assessed. The prevalence of an aortic root dimension ≥40 mm was 28.9%. Independently associated factors in multivariable analyses were: left ventricular end-diastolic diameter [odds ratio 1.06 per year, 95% CI (1.01-1.12), P=0.03] and male sex [odds ratio 3.80, 95% CI (1.65-8.72), P=0.002]. The prevalence of an observed to expected aortic root dimension ratio >1.5 was 6.6%. It was associated with pulmonary atresia [odds ratio 3.04, 95% CI (1.04-8.88), P=0.04] and moderate or severe aortic regurgitation [odds ratio 4.25, 95% CI (1.09-16.5), P=0.04] in univariable analyses, but not side of the aortic arch. No independent predictor was identified. Moderate or severe aortic regurgitation was present in 3.5% of patients.ConclusionsThe prevalence of a dilated aortic root, when defined by an indexed ratio of observed to expected values, is low in adults with surgically repaired TOF. Similarly, moderate or severe aortic regurgitation is uncommon.MHIF BackgroundAortic root pathology has been described in patients with tetralogy of Fallot (TOF), but the scope of the problem remains poorly defined. We sought to determine the prevalence and predictors of aortic root dilatation in adults with repaired TOF. Aortic root pathology has been described in patients with tetralogy of Fallot (TOF), but the scope of the problem remains poorly defined. We sought to determine the prevalence and predictors of aortic root dilatation in adults with repaired TOF. Methods and ResultsA multicenter cross-sectional study was conducted with standardized reassessment of echocardiographic parameters in 474 adults (≥18 years) with surgically repaired TOF or pulmonary atresia with ventricular septal defect. The aortic root was measured in a parasternal long-axis echocardiographic view, at the level of the sinus of Valsalva. The prevalence and predictors of an absolute diameter ≥40 mm and of an observed to expected ratio >1.5 were assessed. The prevalence of an aortic root dimension ≥40 mm was 28.9%. Independently associated factors in multivariable analyses were: left ventricular end-diastolic diameter [odds ratio 1.06 per year, 95% CI (1.01-1.12), P=0.03] and male sex [odds ratio 3.80, 95% CI (1.65-8.72), P=0.002]. The prevalence of an observed to expected aortic root dimension ratio >1.5 was 6.6%. It was associated with pulmonary atresia [odds ratio 3.04, 95% CI (1.04-8.88), P=0.04] and moderate or severe aortic regurgitation [odds ratio 4.25, 95% CI (1.09-16.5), P=0.04] in univariable analyses, but not side of the aortic arch. No independent predictor was identified. Moderate or severe aortic regurgitation was present in 3.5% of patients. A multicenter cross-sectional study was conducted with standardized reassessment of echocardiographic parameters in 474 adults (≥18 years) with surgically repaired TOF or pulmonary atresia with ventricular septal defect. The aortic root was measured in a parasternal long-axis echocardiographic view, at the level of the sinus of Valsalva. The prevalence and predictors of an absolute diameter ≥40 mm and of an observed to expected ratio >1.5 were assessed. The prevalence of an aortic root dimension ≥40 mm was 28.9%. Independently associated factors in multivariable analyses were: left ventricular end-diastolic diameter [odds ratio 1.06 per year, 95% CI (1.01-1.12), P=0.03] and male sex [odds ratio 3.80, 95% CI (1.65-8.72), P=0.002]. The prevalence of an observed to expected aortic root dimension ratio >1.5 was 6.6%. It was associated with pulmonary atresia [odds ratio 3.04, 95% CI (1.04-8.88), P=0.04] and moderate or severe aortic regurgitation [odds ratio 4.25, 95% CI (1.09-16.5), P=0.04] in univariable analyses, but not side of the aortic arch. No independent predictor was identified. Moderate or severe aortic regurgitation was present in 3.5% of patients. ConclusionsThe prevalence of a dilated aortic root, when defined by an indexed ratio of observed to expected values, is low in adults with surgically repaired TOF. Similarly, moderate or severe aortic regurgitation is uncommon.MHIF The prevalence of a dilated aortic root, when defined by an indexed ratio of observed to expected values, is low in adults with surgically repaired TOF. Similarly, moderate or severe aortic regurgitation is uncommon.