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

François-Pierre Mongeon; Michelle Z. Gurvitz; Craig S. Broberg; Jamil AboulHosn; Alexander R. Opotowsky; Joseph D. Kay; Anne Marie Valente; Michael G. Earing; George K. Lui; Susan M. Fernandes; Deborah R. Gersony; Stephen C. Cook; Jennifer Grando Ting; Michelle J. Nickolaus; Michael J. Landzberg; Paul Khairy

CIRCULATIONAHA.112.129585 Published online before print December 6, 2012

Abstract

Background—While aortic root pathology has been described in patients with tetralogy of Fallot (TOF), 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 Results—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 view, in diastole, at the level of the sinus of Valsalva. Prevalence and predictors of an absolute diameter ≥40 mm and of an observed to expected ratio >1.5 were assessed. The aortic root dimension was ≥40 mm in 28.9% [95% confidence interval (CI; 26.9%-30.9%)]. In multivariate analyses, the only independently associated factor was male sex [odds ratio 4.48, 95% CI (1.55-12.89), P=0.006]. The prevalence of an observed to expected aortic root dimension ratio >1.5 was 6.6% [95% CI (5.3%-7.9%)]. It was associated with pulmonary atresia and moderate or severe aortic regurgitation in univariate analyses, but no independent predictor was identified. Side of the aortic arch was not associated with aortic root dimension. The prevalence of moderate or severe aortic regurgitation was 3.5% [95% CI (2.7%-4.2%)].

Conclusions—Although nearly one third of adults with repaired TOF have an aortic root diameter ≥40 mm, the prevalence of a dilated aortic root, when defined by an indexed ratio of observed to expected values, is low. Similarly, moderate or severe aortic regurgitation is uncommon.