Key result
Repaired tetralogy of Fallot is linked to ~58% lower ascending aorta strain vs controls.
Why the study?
Intrinsic aortopathy can lead to late aortic dilatation after tetralogy of Fallot repair, but its extent and prevalence are not known.
Are adults with prior tetralogy of Fallot repair at increased risk for late aortic dilatation and altered aortic elasticity compared to matched controls?
Observational (n=189)
Are adults with prior tetralogy of Fallot repair at increased risk for late aortic dilatation and altered aortic elasticity compared to matched controls?
Absolute Event Rate: 6.4% vs 15.2%
p-value: p=<0.01
Adults late after tetralogy of Fallot repair have a significant prevalence of aortic dilatation and increased aortic stiffness, particularly in males, highlighting the need for careful long-term follow-up.
Significant aortic dilatation and reduced elasticity affect ~25-30% of adults late after TOF repair, especially males; extends observational data but leaves surveillance thresholds open.
Intrinsic aortopathy can lead to dilatation late after tetralogy of Fallot (TOF) repair. Its extent and prevalence are not known. We aimed to assess aortic dimensions and elasticity and to find predictors of aortic dilatation. A total of 126 adults were prospectively included after TOF repair and compared to 63 gender- and age-matched controls. Transthoracic echocardiography was used to assess aortic diameters at the level of the sinuses of Valsalva and ascending aorta and aortic dilatation was defined as z-score >+2. M-mode parameters of the ascending aorta were used to calculate strain, distensibility and stiffness index. TOF patients (mean age 30±9 years; 52% male) had a complete repair at a median age of five (2-49) years; mean follow-up time since repair was 23±7 years. The prevalence of aortic dilatation at the sinuses of Valsalva and ascending aorta was 29% and 24%, respectively. Compared to controls, TOF patients had a higher ascending aorta z-score, lower strain (6.4% [0.0-61.5] vs. 15.2% [0.0-45.0], p<0.01) and higher stiffness index (7.3 [0.8-23.6] vs. 3.1 [0.9-14.1], p<0.01). On multivariate analysis male gender was strongly associated with sinuses of Valsalva dilatation (odds ratio 6.3, 95% confidence interval 1.5-26.3, p=0.01). The prevalence of aortic dilatation late after TOF repair is significant, with a larger and stiffer ascending aorta. Male gender appears to influence aortic root dilatation. This aortopathy requires careful follow-up in order to prevent future complications. Uma possível aortopatia intrínseca poderá condicionar dilatação tardia da aorta na tetralogia de Fallot operada. A sua prevalência e extensão não estão definidas. Pretendemos avaliar as dimensões e a elasticidade da aorta e encontrar preditores da dilatação aórtica. Incluímos prospetivamente 126 adultos operados a tetralogia de Fallot e comparamos com 63 controlos. Avaliamos por ecocardiografia transtorácica os diâmetros dos seios de Valsalva e da aorta ascendente e definimos dilatação aórtica para z-score > +2. Parâmetros modo M da aorta ascendente foram usados para calcular strain, distensibilidade e índice de rigidez. Doentes com tetralogia de Fallot (idade média 30 ± 9 anos; 52% homens) foram operados com uma idade mediana de 5 (2-49) anos; tempo médio de seguimento desde a cirurgia 23 ± 7 anos. A prevalência de dilatação dos seios de Valsalva e da aorta ascendente foi 29% e 24%, respetivamente. Comparado aos controlos, os doentes com tetralogia de Fallot apresentaram maior z-score da aorta ascendente, menor strain (6,4 [0,0-61,5] versus 15,2 [0,0-45,0]%; p < 0,01) e maior índice de rigidez (7,3 [0,8-23,6] versus 3,1 [0,9-14,1]; p < 0,01). Na análise multivariada o sexo masculino associou-se significativamente à dilatação dos seios de Valsalva (odds ratio 6,3, intervalo de confiança de 95% 1,5-26,3; p = 0,01). Na tetralogia de Fallot operada há uma prevalência significativa de dilatação tardia da aorta, com a aorta ascendente maior e mais rígida. O sexo masculino parece influenciar a dilatação da raiz da aorta. Esta aortopatia requer um seguimento cuidadoso para evitar complicações futuras.
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Cruz et al. (2018) conducted an observational in Tetralogy of Fallot (n=189). Repaired tetralogy of Fallot vs. Gender- and age-matched controls was evaluated on Ascending aorta strain (p=<0.01). Repaired tetralogy of Fallot was associated with a larger and stiffer ascending aorta, including significantly lower strain (6.4% vs 15.2%, p<0.01) compared to matched controls.
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