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Late aortic root dilatation and aortic regurgitation in repaired tetralogy of fallot

Korean Journal of Pediatrics 2007;50(10):976-981.
Published online October 15, 2007.
Late aortic root dilatation and aortic regurgitation in repaired tetralogy of fallot
Jeong Eun Kim, Kyong Hur, Hae Sik Kwon, Byung Won Yoo, Jae Young Choi, Jun Hee Sul
Division of Pediatric Cardiology, Yonsei Cardiovascular Center Yonsei University College of Medicine, Seoul, Korea
팔로 4징의 완전 교정술 후 장기 추적 관찰상 나타나는 대동맥근의 확장과 대동맥판 폐쇄부전
김정은, 허경, 권해식, 유병원, 최재영, 설준희
연세대학교 의과대학 심장혈관병원 소아심장과
Correspondence: 
Jae Young Choi, Email: cjy0122@yuhs.ac
Abstract
Purpose
: Aortic valve or aortic root (AoRo) replacement is occasionally required because of AoRo dilatation and aortic regurgitation (AR) in repaired tetralogy of Fallot (TOF). We evaluated AoRo size and possible factors associated with its hemodynamic nature in patients with repaired TOF.
Methods
: We investigated 130 repaired TOF patients more than 15 years of age who followed-up by echocardiography from January 2002 to December 2003. Of 130 patients, we identified 17 patients with AoRo dilatation, which was defined as ratio of expected AoRo size by standard nomogram (AoRo ratio) >1.5 (dilator group), and 113 TOF controls, with AoRo ratio <1.5 (non-dilator group).
Results
: Mean indexed AoRo size (mm/m2) in the first echo was 24?.2 in the dilator group and 18?.4 in the non-dilator group (P<0.0001). AoRo rate of change (mm/year) from the first to latest echo study was 1.6?.8 in dilator group and 0.05?.6 in the non dilator group (P=0.0021). Patients from the dilator group showed a higher prevalence of pulmonary atresia (P=0.031) and a history of aortopulmonary shunt before repair (P=0.048), moderate to severe AR (P=0.0065), and increased left ventricular end-diastolic dimensions (P=0.003).
Conclusions
: A subset of patients late after TOF repair may show progressive dilatation of AoRo. To identify and prevent long-term sequelae in this patient group, regular follow-up and speculation about AoRo after TOF repair is recommended.
Key Words: Tetralogy of Fallot, Aortic sinus, Aortic regurgitation


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