All issues > Volume 50(10); 2007

Original Article

Korean J Pediatr. 2007;50(10):976-981. Published online October 15, 2007.

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

Jeong Eun JE Kim¹, Kyong K Hur¹, Hae Sik HS Kwon¹, Byung Won BW Yoo¹, Jae Young JY Choi¹, Jun Hee JH Sul¹

¹Division of Pediatric Cardiology, Yonsei Cardiovascular Center Yonsei University College of Medicine, Seoul, Korea

Correspondence Jae Young JY 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.

Keywords :Tetralogy of Fallot, Aortic sinus, Aortic regurgitation