Predictors for Dilated Aorta in Repaired and Unrepaired Tetralogy of Fallot

Abstract

Aortic root pathology has been described in patients with Tetralogy of Fallot, although the most common reason for repeat surgery in the adult after TOF repair relates to problems in the right ventricular outflow tract, the aortic root is often forgotten. Objective: We sought to determine those patients with known Fallot tetrallogy at risk for progressive dilatation of the thoracic aorta and explore the common predictors present in this patient group. Methods and Results: A multicenter observational study which enrolled 100 patients (50 surgically repaired and 50 before surgical repair of TOF) with standardized reassessment of echocardiographic parameters and multislice CT angiography of the heart and great vessels data. The data were reviewed and analyzed according to the demographic, morphological, surgical and clinical details. We used standard nomograms and Z score for aortic root dimensions at the level of aortic annulus, sino- 23422% of patients after intra-cardiac repair of TOF. Older age at repair, long shunt to repair interval and residual ventricular septal defect are the most common variables associated with aortopathy and aortic regurgitation in such group of patients. The second important finding is the occurrence of aortic root dilatation in 70% of patients before surgical repair of TOF; whereas male sex and TOF with pulmonary atresia appeared to be the most common variables associated with aortopathy and aortic regurgitation in this group of patients.

Tetralogy of Fallot, left ventricular clot, aortic dissection: rare association

“…1 Progressive aortic root dilatation has been reported in 70% of TOF patients, secondary to increased aortic flow from right-to-left shunting in a dextroposed overriding aorta before surgical repair. 2 This can lead to aortic dissection, but mostly in postoperative cases; if suspected in a preoperative setting, it is important to identify it because it affects surgical outcomes. Here, we describe a case of adult uncorrected TOF that presented with a left ventricular apical clot and DeBakey type I dissection of the aorta.…”