Evaluation of aortic root dilation in adult patients after repair of tetralogy of Fallot

Aortic root dilation is one of the common complications in patients with a history of tetralogy of Fallot total correction (TFTC). We evaluate the frequency of aortic root dilation in adult TFTC patients and analyze probable risk factors related to the dilated aortic root.

We reviewed echocardiography images of 146 adult TFTC patients who admitted at Rajaie Cardiovascular Medical and Research Center from 1383 to 1399 in an observational retrospective cohort study. Sinus of Valsalva (SOV) was measured in parasternal long‑axis view. Aortic root dilation was determined by two definitions. When we adjusted SOV diameter for body surface area and sex, the frequency of aortic root dilation was 68%, with a mean SOV diameter of 3.5 ± 0.7 cm and when we used absolute diameter ≥4 cm for dilated SOV, 22% showed aortic root dilation. By multivariate logistic regression analysis, male sex (odds ratio (OR) = 3.47, P = 0.003), age at the time of TFTC (OR = 1.06, P = 0.009), and aortic regurgitation (OR = 3.97, P = 0.003) were associated with increased adds of dilated aortic root. Three patients underwent aortic surgery, including one case of type A aortic dissection.

Although aortic root dilation was common, aneurysmal dilation and adverse events were not so frequent. Serial evaluation of all segments of the ascending aorta, including the aortic root, is important but not more frequent than previously suggested.