Abstract 18947: What Can We Learn from Serial Echocardiographic Evaluation of the Aorta in Tetralogy of Fallot?
Introduction: Guidelines for management of aortic root (AoR) dilation with known aortopathies recommend surgical repair when the AoR exceeds 5 cm. Patients with tetralogy of Fallot (TOF) may have an associated aortopathy, though aortic dissection is rare. No guidelines exist regarding timing of surgical intervention. We hypothesized that the rate of AoR dilation in adults with repaired TOF would be low and that an AoR > 5 cm would be associated with standard risk factors.
Methods: We performed a retrospective study of all adult TOF patients who underwent a transthoracic echocardiogram (TTE) at our Center. Clinical variables and AoR dimension at the sinus of Valsalva were determined. AoR size was treated as an absolute value and as an observed-to-expected ratio based on standard nomograms.
Results: 266 patients met inclusion criteria. On initial TTE, 91 (34%) patients had an AoR > 4.0 cm, 9 (3%) patients had an AoR > 5.0 cm, and 28 patients (11%) had an observed-to expected AoR > 1.5. Male gender, hypertension, and TOF repair at >5 years-old were associated with an AoR > 5.0 cm while only TOF repair at >5 years-old was associated with an observed-to-expected AoR > 1.5. 4 patients had aortic valve (AV) surgery. One patient with an AoR of 5.8 cm had an aortic dissection following pulmonary valve replacement.
206 patients (77%) had serial TTEs. Mean age at first echo was 35.5 years. Mean time between studies was 5.5 years, and 106 patients had a >5 year latency between TTEs. The mean rate of change for all patients was +0.4 mm/year. 72 patients (35%) had an increase in AoR size. 25 patients (12%) had an increase in AoR size ≥0.5cm. Only time >5 years between TTEs was significantly associated with an increase in AoR ≥0.5 cm (p = 0.014). There was no significant association with either rate of AoR increase or AoR increase ≥0.5 cm and gender, hypertension, degree of AR, AV surgery, right-sided arch, AoR> 5cm, time of repair, or prior pregnancy.
Conclusions: In our cohort of adult patients, AoR dilatation >5.0 cm was uncommon and associated with male gender, hypertension and late repair. The rate of AoR dilation was slow and without clear risk factor. In patients with severe AoR dilation, further study is required to identify significant risk factors for aortic events.
Author Disclosures: M.J. Lewis: None. J. Ginns: None. M. Rosenbaum: None.
- © 2014 by American Heart Association, Inc.