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Stephens EH, Egbe AC, Connolly HM, Vricella LA, Fuller S, Cameron D, Dearani JA. Aortic Dilation and Risk in Patients With Conotruncal Anomalies. Ann Thorac Surg 2024; 117:723-724. [PMID: 38043849 DOI: 10.1016/j.athoracsur.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/05/2023] [Indexed: 12/05/2023]
Affiliation(s)
| | | | | | - Luca A Vricella
- Department of Pediatric Cardiac Surgery, Advocate Children's Hospital, Chicago, Illinois
| | - Stephanie Fuller
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Duke Cameron
- Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
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2
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Shehata M, Bashir R, Al-Alao B, Salmasi MY, Asimakopoulos G, Hoschtitzky A. Type A aortic dissection following a tetralogy of Fallot repair. JTCVS Tech 2023; 22:145-146. [PMID: 38152233 PMCID: PMC10750883 DOI: 10.1016/j.xjtc.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Monicka Shehata
- Department of Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom
| | - Ryan Bashir
- Department of Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom
| | - Bassel Al-Alao
- Department of Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom
| | - M. Yousuf Salmasi
- Department of Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom
| | | | - Andreas Hoschtitzky
- Department of Congenital Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom
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3
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Dasgupta MN, Kaplinski MA, Reddy CD, Collins RT. Patterns of Aortic Dilation in Tetralogy of Fallot: An Analysis of 100 Fetal Echocardiograms Compared With Matched Controls. J Am Heart Assoc 2023; 12:e030083. [PMID: 37929767 PMCID: PMC10727408 DOI: 10.1161/jaha.123.030083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023]
Abstract
Background Although aortic dilation is common in tetralogy of Fallot (TOF), its progression and risk of dissection are not well understood. The mechanism of dilation is primarily attributed to increased flow in utero; an alternative is unequal septation of the truncus arteriosus resulting in a larger aorta and inherently hypoplastic pulmonary artery (PA). If the latter is true, we hypothesize the aorta to PA ratio in TOF is stable throughout gestation, and sums of great artery dimensions are similar to controls. Methods and Results We performed a single-center retrospective study of fetuses with TOF (2014-2020) and matched controls. We compared sums of diameters, circumferences, and cross-sectional areas of the aorta and PA and evaluated the aorta to PA ratio across gestation in 2 TOF subtypes: pulmonary stenosis and atresia (TOF-PA). There were 100 echocardiograms with TOF (36% TOF-PA) with median gestational age of 31 weeks (interquartile range 26.5-34.4) and median maternal age of 34 years (interquartile range 30-37). There were no differences in sums of great artery dimensions between TOF-pulmonary stenosis and controls. In TOF-PA, sums were significantly lower than controls (P values <0.01). The aorta to PA ratio was stable throughout gestation (Pearson's r=0.08 [95% CI, -0.12 to 0.27], -0.06 [95% CI, -0.25 to 0.14]). Conclusions The aorta in fetal TOF is large but grows proportionally throughout gestation, with sums of great artery dimensions similar to controls. TOF-PA appears distinct from TOF-pulmonary stenosis (with smaller sums), warranting further investigation. In conclusion, our findings suggest an intrinsic developmental mechanism contributes to aortic dilation in TOF.
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Affiliation(s)
- Minnie N. Dasgupta
- Department of Pediatrics (Division of Cardiology)Stanford University School of MedicinePalo AltoCAUSA
| | - Michelle A. Kaplinski
- Department of Pediatrics (Division of Cardiology)Stanford University School of MedicinePalo AltoCAUSA
| | - Charitha D. Reddy
- Department of Pediatrics (Division of Cardiology)Stanford University School of MedicinePalo AltoCAUSA
| | - R. Thomas Collins
- Department of Pediatrics (Division of Cardiology)University of Kentucky College of MedicineLexingtonKYUSA
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4
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Yoneyama F, Binsalamah Z, Heinle JS. Comprehensive management of type A acute aortic dissection in the paediatric population with ACTA 2 mutation: case reports and literature review of paediatric aortic dissection. Cardiol Young 2023; 33:2369-2374. [PMID: 37138522 DOI: 10.1017/s1047951123001026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Acute aortic dissection in the paediatric population is rare but lethal. We present two paediatric cases of type A acute aortic dissection that required emergent procedures and were later found to have genetic mutations. High index of suspicion, early clinical diagnosis, prompt treatment, the advantageous collaboration between the paediatric team and aortic surgeons, and familial genetic testing are paramount to achieve a good outcome.
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Affiliation(s)
- Fumiya Yoneyama
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Ziyad Binsalamah
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Jeffery S Heinle
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
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5
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Frankel WC, Roselli EE. Strategies for Complex Reoperative Aortic Arch Reconstruction in Patients With Congenital Heart Disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2023; 26:81-88. [PMID: 36842802 DOI: 10.1053/j.pcsu.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Abstract
Aortic dilation is common in patients with congenital heart disease including those with a bicuspid aortic valve, connective tissue disease, coarctation of the aorta, and conotruncal defects. In addition, neo-aortic dilation has been described in patients after aortic reconstruction including the Norwood procedure, the arterial switch operation, and the Ross procedure. Although aortic catastrophe is rare in patients with congenital heart disease, common pathologic endpoints in these patients likely manifest with similar aortic tissue behavior. A lifelong care model with similar indications for surveillance and prophylactic repair to other more common aortopathies is therefore warranted. Still, reoperative aortic arch reconstruction in these patients is often a complex and high-risk endeavor, and in all cases, a tailored and adaptable plan ensuring adequate myocardial and cerebral protection with appropriate rescue measures is paramount. A surgical team taking on these challenging cases should possess an armamentarium of open, hybrid, and endovascular techniques which can be individualized to a patient's unique anatomy, surgical history, and concomitant lesions as well as the team's measured outcomes and experience.
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Affiliation(s)
- William C Frankel
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH; Aorta Center, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH; Adult Congenital Heart Disease Center, Heart, Vascular and Thoracic Institute, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH.
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6
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Vaikunth SS, Chan JL, Woo JP, Bykhovsky MR, Lui GK, Ma M, Romfh AW, Lamberti J, Mastrodicasa D, Fleischmann D, Fischbein MP. Tetralogy of Fallot and Aortic Dissection: Implications in Management. JACC Case Rep 2022; 4:581-586. [PMID: 35615213 PMCID: PMC9125517 DOI: 10.1016/j.jaccas.2022.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 02/10/2022] [Accepted: 02/27/2022] [Indexed: 11/29/2022]
Abstract
We present the case of a 61-year-old man with tetralogy of Fallot postrepair and mechanical aortic valve replacement with an aortic root/ascending/arch aneurysm with chronic type A aortic dissection. He underwent uncomplicated aortic root and total arch replacement. Continued surveillance for aortic aneurysm is necessary in the tetralogy of Fallot population. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Sumeet S. Vaikunth
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Joshua L. Chan
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jennifer P. Woo
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Michael R. Bykhovsky
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - George K. Lui
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA,Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Michael Ma
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Anitra W. Romfh
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA,Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California, USA
| | - John Lamberti
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Domenico Mastrodicasa
- Department of Radiology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Dominik Fleischmann
- Department of Radiology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Michael P. Fischbein
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California, USA,Address for correspondence: Dr Michael P. Fischbein, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Falk CVRB, 300 Pasteur Drive, Falk CVRB ULN MC5407, Stanford, California 94305, USA.
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7
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Mohammed AFA, Frick M, Kerst G, Hatam N, Elgamal MAF, Essa KM, Hövels-Gürich HH, Vazquez-Jimenez JF, Zayat R. Proximal Aortic Dilatation and Pulmonary Valve Replacement in Patients with Repaired Tetralogy of Fallot: Is There a Relationship? A Cardiac Magnetic Resonance Imaging Study. J Clin Med 2021; 10:5296. [PMID: 34830578 PMCID: PMC8625773 DOI: 10.3390/jcm10225296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/26/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022] Open
Abstract
Aortopathy is a known complication whose incidence is growing within the population of tetralogy of Fallot (TOF) patients. Its pathology and relationship with other comorbidities remain unclear. This study was designed to determine the prevalence and predictors of proximal aortic dilatation after TOF repair. We retrospectively investigated all patients who underwent follow-up cardiac magnetic resonance imaging (CMR; at least 4 years after TOF repair) between March 2004 and December 2019. The dimensions at the ascending aorta (AAo) and sinus of Valsalva (SoV) levels were measured. Aortic dilatation was defined as an internal aortic diameter that was >2 standard deviation of the previously published normal values. We included 77 patients (mean age 28.9 ± 10.5 years, 41.5% female, mean follow-up of 24.5 ± 8.1 years). AAo and SoV were dilated in 19 (24.6%) and 43 (55.8%) patients, respectively. Patients with dilated AAo and SoV were older during the corrective surgery (p < 0.001 and p = 0.004, respectively) and during CMR (p = 0.002 and 0.024, respectively) than patients without AAo and SoV dilatation. Patients of the dilated AAo group were more likely to have prior palliative shunt (p = 0.008), longer shunt duration (p = 0.005), and a higher degree of aortic valve regurgitation (AR) fraction (p < 0.001) and to undergo pulmonary (PVR) and/or aortic valve replacement (p < 0.001 and p = 0.013, respectively). PVR (p = 0.048, odds ratio = 6.413, and 95% CI = 1.013-40.619) and higher AR fraction (p = 0.031, odds ratio = 1.194, and 95% CI = 1.017-1.403) were independent predictors for AAo dilatation. Aortopathy is a common progressive complication that may require reintervention and lifelong follow-up. Our study shows that proximal aortic dilatation may be attributed to factors that increase the volume overload across the proximal aorta, including late corrective surgery and palliative shunt. We also found that PVR and higher AR fraction are independent predictors of AAo dilatation.
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Affiliation(s)
- Ahmed Farghal A. Mohammed
- Department of Pediatric Cardiac Surgery, RWTH University Hospital Aachen, Faculty of Medicine, Pauwelsstr. 30, 52074 Aachen, Germany
- Department of Cardiothoracic Surgery, Qena University Hospitals, Faculty of Medicine, South Valley University, Qena 83511, Egypt;
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Faculty of Medicine, Pauwelsstr. 30, 52074 Aachen, Germany; (N.H.); (R.Z.)
| | - Michael Frick
- Department of Cardiology, RWTH University Hospital Aachen, Faculty of Medicine, Pauwelsstr. 30, 52070 Aachen, Germany;
| | - Gunter Kerst
- Department of Pediatric Cardiology, RWTH University Hospital Aachen, Faculty of Medicine, Pauwelsstr. 30, 52074 Aachen, Germany; (G.K.); (H.H.H.-G.)
| | - Nima Hatam
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Faculty of Medicine, Pauwelsstr. 30, 52074 Aachen, Germany; (N.H.); (R.Z.)
| | | | - Karam M. Essa
- Department of Cardiothoracic Surgery, Qena University Hospitals, Faculty of Medicine, South Valley University, Qena 83511, Egypt;
| | - Hedwig H. Hövels-Gürich
- Department of Pediatric Cardiology, RWTH University Hospital Aachen, Faculty of Medicine, Pauwelsstr. 30, 52074 Aachen, Germany; (G.K.); (H.H.H.-G.)
| | - Jaime F. Vazquez-Jimenez
- Department of Pediatric Cardiac Surgery, RWTH University Hospital Aachen, Faculty of Medicine, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Rashad Zayat
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Faculty of Medicine, Pauwelsstr. 30, 52074 Aachen, Germany; (N.H.); (R.Z.)
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8
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Buratto E, Konstantinov IE. Valve-sparing aortic root surgery in children and adults with congenital heart disease. J Thorac Cardiovasc Surg 2021; 162:955-962. [DOI: 10.1016/j.jtcvs.2020.08.116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/04/2020] [Accepted: 08/11/2020] [Indexed: 12/12/2022]
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Abstract
Introduction: Advancements in surgery and management have resulted in a growing population of aging adults with tetralogy of Fallot (TOF). As a result, there has been a parallel growth in late complications associated with the sequelae from the underlying cardiac anomalies as well as the surgical and other interventional treatments.Areas covered: Here, we review challenges related to an aging population of patients with TOF, particularly late complications, and highlight advances in management and key areas for future research. Pulmonary regurgitation, heart failure, arrhythmias, and aortic complications are some of these late complications. There is also a growing incidence of acquired cardiovascular disease, obesity, and diabetes associated with aging. Management of these late complications and acquired comorbidities continues to evolve as research provides insights into long-term outcomes from medical therapies and surgical interventions.Expert opinion: The management of an aging TOF population will continue to transform with advances in imaging technologies to identify subclinical disease and valve replacement technologies that will prevent and mitigate disease progression. In the coming years, we speculate that there will be more data to support the use of novel heart failure therapies in TOF and consensus guidelines on the management of refractory arrhythmias and aortic complications.
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Affiliation(s)
- Jennifer P Woo
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, California, USA
| | - Doff B McElhinney
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, California, USA
| | - George K Lui
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, California, USA
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10
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Abstract
The number of rTOF patients who survive into adulthood is steadily rising, with currently more than 90% reaching the third decade of life. However, rTOF patients are not cured, but rather have a lifelong increased risk for cardiac and non-cardiac complications. Heart failure is recognized as a significant complication. Its occurrence is strongly associated with adverse outcome. Unfortunately, conventional concepts of heart failure may not be directly applicable in this patient group. This article presents a review of the current knowledge on HF in rTOF patients, including incidence and prevalence, the most common mechanisms of heart failure, i.e., valvular pathologies, shunt lesions, left atrial hypertension, primary left heart and right heart failure, arrhythmias, and coronary artery disease. In addition, we will review information regarding extracardiac complications, risk factors for the development of heart failure, clinical impact and prognosis, and assessment possibilities, particularly of the right ventricle, as well as management strategies. We explore potential future concepts that may stimulate further research into this field.
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11
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Stone ML, Schäfer M, von Alvensleben JC, Browne LP, Di Maria M, Campbell DN, Jaggers J, Mitchell MB. Increased Aortic Stiffness and Left Ventricular Dysfunction Exist After Truncus Arteriosus Repair. Ann Thorac Surg 2020; 112:809-815. [PMID: 33307069 DOI: 10.1016/j.athoracsur.2020.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The purpose of this study was to determine whether aortic biomechanical properties are abnormal in children with repaired truncus arteriosus (TA) and to concurrently evaluate left ventricular (LV) function post-repair utilizing a novel platform for regional ventricular function. METHODS Cardiac magnetic resonance (CMR) studies from 26 children (mean age: 15.6 ± 7.2 years) post-TA repair were compared with 20 normal controls (mean age: 14.7 ± 2.6 years). Parameters of aortic stiffness (pulse wave velocity and relative area change) were measured. Flow hemodynamic metrics (aortic regurgitant fraction, peak systolic flow, and peak systolic velocity) and LV function (volumetric data, ejection fraction, regional wall strain) were also compared. RESULTS Ascending aortic pulse wave velocity was elevated and relative area change was decreased in TA patients compared with controls. Patients post-TA repair demonstrated elevated end diastolic and end systolic volumes in addition to decreased regional wall strain and increased mechanical dyssynchrony. LV functional changes were independent of aortic biomechanical properties. CONCLUSIONS Children with repaired TA have increased ascending aortic stiffness and altered LV function as measured by CMR imaging. Longitudinal studies and advanced CMR assessments are warranted to better determine the long-term potential for late aortic complications and to optimize both the medical and surgical management of these patients after TA repair.
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Affiliation(s)
- Matthew L Stone
- Division of Pediatric Cardiothoracic Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado.
| | - Michal Schäfer
- Department of Pediatric Cardiology, Children's Hospital Colorado, Aurora, Colorado
| | | | - Lorna P Browne
- Department of Pediatric Radiology, Children's Hospital Colorado, Aurora, Colorado
| | - Michael Di Maria
- Department of Pediatric Cardiology, Children's Hospital Colorado, Aurora, Colorado
| | - David N Campbell
- Division of Pediatric Cardiothoracic Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - James Jaggers
- Division of Pediatric Cardiothoracic Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Max B Mitchell
- Division of Pediatric Cardiothoracic Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
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12
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Chow PC, Rocha BA, Au TWK, Yung TC. Aortic dissection in a Chinese patient 31 years after surgical repair of tetralogy of Fallot. J Cardiol Cases 2020; 22:174-176. [PMID: 33014199 DOI: 10.1016/j.jccase.2020.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/11/2020] [Accepted: 05/27/2020] [Indexed: 12/30/2022] Open
Abstract
Aortic dilation has been increasingly recognized in congenital heart diseases, and aortic dissection is one of the important complications. We report a case of aortic dissection in a patient 31 years after repair of tetralogy of Fallot (TOF) and review reported cases. While aortic dissection is uncommon, aortic dilation is common among patients with repaired TOF and it appeared progressive in some patients. Based on the reported cases, progressive aortic dilation appeared as the pre-requisite for aortic dissection, although other factors might be involved. Regular surveillance and monitoring for aortic complications should be incorporated into clinical practice. <Learning objective: Aortic dilation is common but aortic dissection is uncommon in patients with tetralogy of Fallot, and threshold for prophylactic surgery is lacking. Recognition of progressive aortic dilation is important to identify patients at risk of aortic dissection in tetralogy of Fallot.>.
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Affiliation(s)
- Pak-Cheong Chow
- Department of Paediatric Cardiology, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Barnabe A Rocha
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Timmy W K Au
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Tak-Cheung Yung
- Department of Paediatric Cardiology, Queen Mary Hospital, Hong Kong Special Administrative Region
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13
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Egbe AC, Crestanello J, Miranda WR, Connolly HM. Thoracic Aortic Dissection in Tetralogy of Fallot: A Review of the National Inpatient Sample Database. J Am Heart Assoc 2020; 8:e011943. [PMID: 30871391 PMCID: PMC6475048 DOI: 10.1161/jaha.119.011943] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Thoracic aortic aneurysm is common in patients with tetralogy of Fallot (TOF); the incidence of thoracic aortic dissection (TAD) is unknown, but generally considered to be uncommon. The purpose of this study was to determine incidence and risk factors for TAD in TOF patients. Methods and Results This work is a retrospective review of the National Inpatient Sample (NIS) database for cases of ascending TAD among all hospital admissions in adults with TOF, 2000–2014. Of 18 353 admissions in TOF patients, 11 (0.06%; 6 per 10 000 admissions) of these were TAD‐related admissions. For the TAD‐related admissions, mean age was 49.8±7.2 years; aortic surgical interventions were performed during 8 of the admissions, and overall in‐hospital mortality was 45% (5 of 11). Risk factors associated with TAD‐related admission were age >60 years (odds ratio, 2.41; 95% CI, 1.23–3.25; P=0.013), male sex (odds ratio, 6.91; 95% CI, 4.85–8.54; P<0.001), and hypertension (odds ratio, 1.74; 95% CI, 1.06–3.19; P=0.037). Conclusions This is the first population‐based study of TAD outcomes in patients with TOF, and it showed a low risk of TAD in this population. This has important clinical implication with regard to surveillance and surgical intervention. Given that prevalence of thoracic aortic aneurysm is higher in TOF patients compared with the general population; therefore, making clinical decisions based on outcomes data and practice guidelines derived from patients with degenerative and bicuspid aortic valve–related aortopathies may lead to overtreatment. Further studies are required to better understand the pathobiology of this disease in order to make evidence‐based recommendations for surveillance and treatment.
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Affiliation(s)
- Alexander C Egbe
- 1 Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | | | | | - Heidi M Connolly
- 1 Department of Cardiovascular Medicine Mayo Clinic Rochester MN
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14
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Nishimura Y, Yasutsune T, Shimajiri S, Jinzai Y, Ikushima E, Kishigami T, Takigawa T. Significant delayed aortic dilatation after tetralogy of Fallot repair: a case report. Surg Case Rep 2020; 6:173. [PMID: 32681395 PMCID: PMC7367997 DOI: 10.1186/s40792-020-00935-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/07/2020] [Indexed: 11/24/2022] Open
Abstract
Background Aortic dilatation may occur in some patients even after complete repair of tetralogy of Fallot (TOF). The progression rate of the aortic diameter is so slow, and the incidence of aortic dissection is so low that it is suspected that frequent imaging of the aorta may not be necessary. Case presentation We describe an asymptomatic 41-year-old man with hypertension in whom aortic dilatation was accidentally discovered 39 years after TOF repair. He underwent ambulatory follow-up without any difficulty for 21 years after the repair. Contrast-enhanced computed tomography revealed significant aortic dilatation (maximum diameter of 88 mm at the sinus of Valsalva), and echocardiography revealed severe aortic regurgitation, which seemed to progress during the last 18 years without any evaluation or follow-up. The Bentall procedure was successfully performed using a valved graft, under deep hypothermic circulatory arrest with antegrade cerebral perfusion, and his postoperative course was uneventful. Histopathological examination of ascending aorta specimens revealed severe cystic medial degeneration. Conclusions Keeping in mind that a patient with rapid progression of the aortic dilatation after TOF repair exist, periodic follow-up for evaluation of the aorta is essential in patients with TOF.
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Affiliation(s)
- Yosuke Nishimura
- Department of Cardiovascular Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
| | - Toru Yasutsune
- Department of Cardiovascular Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Shohei Shimajiri
- Department of Surgical Pathology, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Yuki Jinzai
- Department of Cardiovascular Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Eigo Ikushima
- Department of Cardiovascular Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Takehiro Kishigami
- Department of Cardiovascular Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Tomoya Takigawa
- Department of Cardiovascular Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
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15
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Abstract
Aortic dilatation is common in patients with congenital heart disease and is seen in patients with bicuspid aortic valve and those with conotruncal congenital heart defects. It is important to identify patients with bicuspid aortic valve at high risk for aortic dissection. High-risk patients include those with the aortic root phenotype and those with syndromic or familial aortopathies including Marfan syndrome, Loeys-Dietz syndrome, and Turner syndrome. Aortic dilatation is common in patients with conotruncal congenital heart defects and rarely results in aortic dissection.
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16
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Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2020; 139:e698-e800. [PMID: 30586767 DOI: 10.1161/cir.0000000000000603] [Citation(s) in RCA: 226] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Karen K Stout
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Curt J Daniels
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Jamil A Aboulhosn
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Biykem Bozkurt
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Craig S Broberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Jack M Colman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Stephen R Crumb
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Joseph A Dearani
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Stephanie Fuller
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Michelle Gurvitz
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Paul Khairy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Michael J Landzberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Arwa Saidi
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Anne Marie Valente
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - George F Van Hare
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
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Chowdhury UK, George N, Gudala V, Gupta A, Avneesh S, Sankhyan LK, Malik V, Kumar P. Bentall's Procedure for Annuloaortic Ectasia and Severe Aortic Regurgitation in a Patient With Repaired Tetralogy of Fallot and Aortic Valvular Reconstruction. World J Pediatr Congenit Heart Surg 2019; 10:648-650. [PMID: 31496413 DOI: 10.1177/2150135119865162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 21-year-old female patient with repaired tetralogy of Fallot and aortic valvular reconstruction with aneurysmal aortic root and severe aortic regurgitation underwent aortic root replacement. Intrinsic aortopathy in tetralogy of Fallot and its surgical importance are highlighted.
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Affiliation(s)
- Ujjwal Kumar Chowdhury
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Niwin George
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vasubabu Gudala
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Anish Gupta
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sheil Avneesh
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Lakshmi Kumari Sankhyan
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vishwas Malik
- Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Pramod Kumar
- Department of Cardiac Radiology, All India Institute of Medical Sciences, New Delhi, India
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18
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d'Udekem Y, Tweddell JS, Karl TR. The great debate series: surgical treatment of aortic valve abnormalities in children. Eur J Cardiothorac Surg 2019; 53:919-931. [PMID: 29668975 DOI: 10.1093/ejcts/ezy069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/22/2018] [Indexed: 11/13/2022] Open
Abstract
This article is the latest in an EJCTS series entitled 'The Great Debates'. We have chosen the topic of aortic valve (AoV) surgery in children, with a focus on infants and neonates. The topic was selected due to the significant challenges that AoV problems in the young may present to the surgical team. There are many areas of active controversy, despite the vast accumulated world experience. We have tried to incorporate many of these issues in the questions posed, not claiming to be all-inclusive. The individuals invited to this debate are experts in paediatric valve surgery, with broad and successful clinical experiences on multiple continents. We hope that the facts and opinions presented in this debate will generate interest and discussion and perhaps prove useful in decision-making for future complex valve cases.
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Affiliation(s)
- Yves d'Udekem
- Cardiac Surgical Unit, Royal Children's Hospital, Melbourne, VIC, Australia
| | - James S Tweddell
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Tom R Karl
- Johns Hopkins All Children's Heart Institute, St. Petersburg, FL, USA.,European Journal of Cardio-Thoracic Surgery
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19
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Schäfer M, Browne LP, Morgan GJ, Barker AJ, Fonseca B, Ivy DD, Mitchell MB. Reduced proximal aortic compliance and elevated wall shear stress after early repair of tetralogy of Fallot. J Thorac Cardiovasc Surg 2018; 156:2239-2249. [DOI: 10.1016/j.jtcvs.2018.08.081] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/23/2018] [Accepted: 08/31/2018] [Indexed: 02/05/2023]
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20
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Grotenhuis HB, Dallaire F, Verpalen IM, van den Akker MJ, Mertens L, Friedberg MK. Aortic Root Dilatation and Aortic-Related Complications in Children After Tetralogy of Fallot Repair. Circ Cardiovasc Imaging 2018; 11:e007611. [DOI: 10.1161/circimaging.118.007611] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Heynric B. Grotenhuis
- Division of Cardiology, Department of Pediatrics, Wilhelmina Children’s Hospital, University of Utrecht, The Netherlands (H.B.G.)
| | - Frederic Dallaire
- Division of Cardiology, Department of Pediatrics, Centre Hospitalier de l’Université de Sherbrooke, University of Sherbrooke, QC, Canada (F.D.)
| | - Inez M. Verpalen
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, The Netherlands (I.M.V., M.J.E.v.d.A.)
| | - Michelle J.E. van den Akker
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, The Netherlands (I.M.V., M.J.E.v.d.A.)
| | - Luc Mertens
- The Labatt Family Heart Center, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, ON, Canada (L.M., M.K.F.)
| | - Mark K. Friedberg
- The Labatt Family Heart Center, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, ON, Canada (L.M., M.K.F.)
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Abstract
A bicuspid aortic valve and/or coarctation of the aorta (COA) are often associated with dilatation of the ascending aorta and para-coarctation. Congenital heart diseases (CHD), such as truncus arteriosus, transposition of the great arteries (TGA), tetralogy of Fallot (TOF), hypoplastic left heart syndrome (HLHS), single ventricle with pulmonary stenosis/atresia and the Fontan procedure, are also associated with aortic root dilatation, aneurysm and rarely, dissection, which can be fatal and require aortic valve and root surgery. A significant subset of adults with complex CHD exhibit progressive dilatation of the aortic root even after repair due to aortic medial degeneration. Medial degeneration in the ascending aorta is prevalent among the above CHD. In Marfan syndrome, bicuspid aortic valve and COA, medial degeneration is more extensive and severe than in another complex CHD. Accordingly, the incidence of ascending aortic dilatation, dissection and rupture is higher in the former. This aortic medial degeneration in CHD may either be intrinsic or secondary to the increased volume overload of the aortic root due to right-to-left shunting, or a combination of both. The association of aortic pathophysiological abnormalities, aortic dilatation and aorto-ventricular interaction is clinically referred to as "aortopathy". The major purpose of medical treatment for aortopathy is to reduce the structural changes within the aortic wall and slow down the progression of aortic dilatation to reduce the risk of cardiovascular events. Several medications have been studied, including β-blockers, angiotensin II type I (AT1) receptor blockers (ARBs) and Ca-antagonists. However, the results, except for Marfan syndrome, are limited. In aortopathy, concomitant aortic valve and aortic root repair/replacement is required. The Bentall operation comprises root replacement with an aortic tube graft and mechanical valve, and has been widely applied. On the other hand, valve-sparing operations have been developed in order to preserve the aortic valve.
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Affiliation(s)
- Koichiro Niwa
- Department of Cardiology, Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan
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22
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Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018; 73:e81-e192. [PMID: 30121239 DOI: 10.1016/j.jacc.2018.08.1029] [Citation(s) in RCA: 464] [Impact Index Per Article: 77.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Aortic dilatation after tetralogy of Fallot repair: A ghost from the past or a problem in the future? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Cruz C, Pinho T, Ribeiro V, Dias CC, Silva Cardoso J, Maciel MJ. Aortic dilatation after tetralogy of Fallot repair: A ghost from the past or a problem in the future? Rev Port Cardiol 2018; 37:549-557. [PMID: 30008310 DOI: 10.1016/j.repc.2017.10.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 09/17/2017] [Accepted: 10/01/2017] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION AND AIMS Intrinsic aortopathy can lead to dilatation late after tetralogy of Fallot (TOF) repair. Its extent and prevalence are not known. We aimed to assess aortic dimensions and elasticity and to find predictors of aortic dilatation. METHODS A total of 126 adults were prospectively included after TOF repair and compared to 63 gender- and age-matched controls. Transthoracic echocardiography was used to assess aortic diameters at the level of the sinuses of Valsalva and ascending aorta and aortic dilatation was defined as z-score >+2. M-mode parameters of the ascending aorta were used to calculate strain, distensibility and stiffness index. RESULTS TOF patients (mean age 30±9 years; 52% male) had a complete repair at a median age of five (2-49) years; mean follow-up time since repair was 23±7 years. The prevalence of aortic dilatation at the sinuses of Valsalva and ascending aorta was 29% and 24%, respectively. Compared to controls, TOF patients had a higher ascending aorta z-score, lower strain (6.4% [0.0-61.5] vs. 15.2% [0.0-45.0], p<0.01) and higher stiffness index (7.3 [0.8-23.6] vs. 3.1 [0.9-14.1], p<0.01). On multivariate analysis male gender was strongly associated with sinuses of Valsalva dilatation (odds ratio 6.3, 95% confidence interval 1.5-26.3, p=0.01). CONCLUSIONS The prevalence of aortic dilatation late after TOF repair is significant, with a larger and stiffer ascending aorta. Male gender appears to influence aortic root dilatation. This aortopathy requires careful follow-up in order to prevent future complications.
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Affiliation(s)
- Cristina Cruz
- Department of Cardiology, Centro Hospitalar São João, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Teresa Pinho
- Department of Cardiology, Centro Hospitalar São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Vânia Ribeiro
- Department of Cardiology, Centro Hospitalar São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Cláudia Camila Dias
- Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Silva Cardoso
- Department of Cardiology, Centro Hospitalar São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Maria Júlia Maciel
- Department of Cardiology, Centro Hospitalar São João, Faculty of Medicine, University of Porto, Porto, Portugal
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Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e348-e392. [DOI: 10.1161/cir.0000000000000535] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Life expectancy and quality of life for those born with congenital heart disease (CHD) have greatly improved over the past 3 decades. While representing a great advance for these patients, who have been able to move from childhood to successful adult lives in increasing numbers, this development has resulted in an epidemiological shift and a generation of patients who are at risk of developing chronic multisystem disease in adulthood. Noncardiac complications significantly contribute to the morbidity and mortality of adults with CHD. Reduced survival has been documented in patients with CHD with renal dysfunction, restrictive lung disease, anemia, and cirrhosis. Furthermore, as this population ages, atherosclerotic cardiovascular disease and its risk factors are becoming increasingly prevalent. Disorders of psychosocial and cognitive development are key factors affecting the quality of life of these individuals. It is incumbent on physicians who care for patients with CHD to be mindful of the effects that disease of organs other than the heart may have on the well-being of adults with CHD. Further research is needed to understand how these noncardiac complications may affect the long-term outcome in these patients and what modifiable factors can be targeted for preventive intervention.
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Jariwala P, Kale SS, Sepur L, Padma Kumar EA. Tetralogy of Fallot, left ventricular clot, aortic dissection: rare association. Asian Cardiovasc Thorac Ann 2017. [PMID: 28622727 DOI: 10.1177/0218492317717420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cases of uncorrected adult tetralogy of Fallot are rare and mostly manifest secondary to complications. A 30-year-old man presented with progressive breathlessness and severe chest discomfort. Echocardiography revealed tetralogy of Fallot with a left ventricular apical clot and DeBakey type I dissection of the aorta. The patient underwent successful surgical correction. The combination of preoperative complications in the setting of uncorrected tetralogy of Fallot, such as a left ventricular clot and DeBakey type I dissection of the aorta, is very rare.
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Affiliation(s)
- Pankaj Jariwala
- 1 Department of Cardiology, Maxcure-Mediciti Hospitals, Hyderabad, Telangana, India
| | - Satya Sridhar Kale
- 2 Department of Cardiothoracic Surgery, Maxcure-Mediciti Hospitals, Hyderabad, Telangana, India
| | - Lakshmana Sepur
- 3 Department of Cardiac Anesthesiology, Maxcure-Mediciti Hospitals, Hyderabad, Telangana, India
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Kuijpers JM, Mulder BJM. Aortopathies in adult congenital heart disease and genetic aortopathy syndromes: management strategies and indications for surgery. Heart 2017; 103:952-966. [DOI: 10.1136/heartjnl-2015-308626] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Kay WA. Molecular and Genetic Insights into Thoracic Aortic Dilation in Conotruncal Heart Defects. Front Cardiovasc Med 2016; 3:18. [PMID: 27376074 PMCID: PMC4894874 DOI: 10.3389/fcvm.2016.00018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/23/2016] [Indexed: 11/13/2022] Open
Abstract
Thoracic aortic dilation (AD) has commonly been described in conotruncal defects (CTDs), such as tetralogy of Fallot, double outlet right ventricle and transposition of the great arteries, and truncus arteriosus. Several theories for this have been devised, but fairly recent data indicate that there is likely an underlying histologic abnormality, similar to that seen in Marfan and other connective tissue disease. The majority of aortic dissection in the general population occurs after the age of 45 years, and there have been very few case reports of aortic dissection in CTD. Given advances in cardiac surgery and increasing survival over the past several decades, there has been rising concern that, as patients who have survived surgical correction of these defects age, there may be increased morbidity and mortality due to aortic dissection and aortic regurgitation. This review discusses the most recent developments in research into AD in CTD, including associated genetic mutations.
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Affiliation(s)
- W Aaron Kay
- Department of Medicine, Krannert Institute of Cardiology, Indiana University School of Medicine , Indianapolis, IN , USA
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29
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Baliulis G, Ropponen JO, Salmon TP, Kaarne MO. Valve-sparing aortic root replacement in adult patients previously operated for congenital heart defects: an initial experience: Table 1:. Eur J Cardiothorac Surg 2015; 50:155-9. [DOI: 10.1093/ejcts/ezv446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 11/26/2015] [Indexed: 11/13/2022] Open
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30
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Thoracic aortic dissection and rupture in conotruncal cardiac defects: A population-based study. Int J Cardiol 2015; 184:521-527. [DOI: 10.1016/j.ijcard.2015.03.061] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 01/06/2015] [Accepted: 03/03/2015] [Indexed: 11/27/2022]
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31
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Abstract
In patients born with congenital heart disease, dilatation of the aorta is a frequent feature at presentation and during follow-up after surgical intervention. This review provides an overview of the pathologies associated with aortopathy, and discusses the current knowledge on pathophysiology, evolution, and treatment guidelines of the aortic disease associated with congenital heart defects.
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Affiliation(s)
- Katrien Francois
- Department of Cardiac Surgery, University Hospital Gent, De Pintelaan, Gent, Belgium
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32
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Kogon BE, Rosenblum JM, Mori M. Current Readings: Issues Surrounding Pulmonary Valve Replacement in Repaired Tetralogy of Fallot. Semin Thorac Cardiovasc Surg 2015; 27:57-64. [DOI: 10.1053/j.semtcvs.2015.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2015] [Indexed: 11/11/2022]
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33
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Aortic dissection in a patient with a dilated aortic root following tetralogy of Fallot repair. Int J Cardiol 2014; 174:833-4. [DOI: 10.1016/j.ijcard.2014.04.167] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/13/2014] [Indexed: 11/21/2022]
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34
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Christensen JT, Lu JC, Donohue J, Yu S, Mahani MG, Agarwal PP, Dorfman AL. Relation of aortic stiffness and strain by cardiovascular magnetic resonance imaging to age in repaired tetralogy of fallot. Am J Cardiol 2014; 113:1031-5. [PMID: 24480147 DOI: 10.1016/j.amjcard.2013.11.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 11/26/2013] [Accepted: 11/26/2013] [Indexed: 11/30/2022]
Abstract
Patients with tetralogy of Fallot (TOF) have abnormal aortic properties. It is not known if this increases the risk for aneurysm formation. We sought to identify clinical and cardiovascular magnetic resonance (CMR) imaging patient characteristics associated with worsened aortic pulse wave velocity (PWV) and aortic strain in patients with repaired TOF. In 124 patients with TOF undergoing CMR (median age 24.6 years, interquartile range 17.8 to 34.2), left and right ventricular volumetric data, aortic PWV, and aortic strain were evaluated. Increased PWV positively correlated with age at repair (r = 0.3, p = 0.001) and cross-sectional ascending aortic area (r = 0.34, p <0.001) and was associated with a history of shunt placement (p = 0.01). Decreased aortic strain also correlated with age at TOF repair (r = -0.5, p <0.001), cross-sectional ascending aortic area (r = -0.43, p <0.001), aortic regurgitation (r = -0.46, p ≤0.001), and history of shunt placement (p <0.001). In a multivariate regression model controlling for history of shunt placement, use of cardiac medication, and aortic regurgitation, age at CMR was significantly associated with PWV (p = 0.005), whereas age at repair trended toward significance (p = 0.06). In conclusion, patients with TOF have abnormal aortic properties correlated with greater age, which may be associated with later repair. Longitudinal data are necessary to assess the risk of aortic aneurysm and dissection as the TOF population grows older. Functional imaging of the aorta by CMR may be useful in predicting risk and assessing vascular health.
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Myers PO, del Nido PJ, Emani SM, Marx GR, Baird CW. Valve-sparing aortic root replacement and remodeling with complex aortic valve reconstruction in children and young adults with moderate or severe aortic regurgitation. J Thorac Cardiovasc Surg 2014; 147:1768-74. [PMID: 24667028 DOI: 10.1016/j.jtcvs.2014.02.055] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 02/11/2014] [Accepted: 02/18/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The durability of valve-sparing aortic root procedures with aortic regurgitation due to leaflet disease is questioned. Here, we review our experience in combined aortic root and valve reconstruction in children and young adults. METHODS All valve-sparing aortic root procedures from 2000 to 2012 were reviewed, and patients with aortic valve repair beyond resuspension were included. Root procedures were classified as replacement with reimplantation, root remodeling, or aortic annular and sinotubular junction stabilization. The primary end point was structural valve deterioration, a composite of aortic valve reoperation and/or moderate or greater regurgitation at follow-up. RESULTS Thirty-four patients were included during the study period. The surgery consisted of reimplantation in 13 patients, remodeling in 16 patients, and annular and sinotubular junction stabilization in 5 patients. Valve repair consisted of leaflet procedures in 26 patients and subannular reduction in 15 patients. During a median follow-up of 4.2 months (range, 2 weeks-8 years), there were 5 reoperations for aortic valve replacement due to aortic regurgitation, and 2 patients presented with moderate or greater regurgitation. Freedom from structural valve deterioration was 70.1% ± 10.3% at 1 year and remained stable thereafter, although it was significantly worse in the reimplantation group (P = .039). A more severe degree of preoperative aortic regurgitation (P = .001) and smaller graft to aortic annulus ratio (P = .003) were predictors of structural valve deterioration. CONCLUSIONS Valve-sparing root and valve reconstruction can be done with low operative risk and allows valve preservation in most patients. These data should question the assumption that reimplantation is superior when associated with complex valve reconstruction.
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Affiliation(s)
- Patrick O Myers
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass; Department of Cardiovascular Surgery, Geneva University Hospitals and School of Medicine, Geneva, Switzerland
| | - Pedro J del Nido
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Sitaram M Emani
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Gerald R Marx
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Christopher W Baird
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
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Le Gloan L, Mongeon FP, Mercier LA, Dore A, Marcotte F, Ibrahim R, Asgar A, Miro J, Poirier N, Khairy P. Tetralogy of Fallot and aortic root disease. Expert Rev Cardiovasc Ther 2014; 11:233-8. [DOI: 10.1586/erc.12.170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Outcomes After Operations for Bicuspid Aortic Valve Disease in the Pediatric Population. Ann Thorac Surg 2013; 96:2175-83. [DOI: 10.1016/j.athoracsur.2013.07.130] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 07/22/2013] [Accepted: 07/23/2013] [Indexed: 12/20/2022]
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Shamszad P, Barnes JN, Morris SA. Aortic Dissection in Hospitalized Children and Young Adults: A Multiinstitutional Study. CONGENIT HEART DIS 2013; 9:54-62. [DOI: 10.1111/chd.12090] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2013] [Indexed: 02/04/2023]
Affiliation(s)
- Pirouz Shamszad
- Lillie Frank Abercrombie Section of Cardiology; Department of Pediatrics; Texas Children's Hospital; Baylor College of Medicine; Houston Tex USA
| | | | - Shaine A. Morris
- Lillie Frank Abercrombie Section of Cardiology; Department of Pediatrics; Texas Children's Hospital; Baylor College of Medicine; Houston Tex USA
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Mongeon FP, Gurvitz MZ, Broberg CS, Aboulhosn J, Opotowsky AR, Kay JD, Valente AM, Earing MG, Lui GK, Fernandes SM, Gersony DR, Cook SC, Ting JG, Nickolaus MJ, Landzberg MJ, Khairy P. Aortic Root Dilatation in Adults with Surgically Repaired Tetralogy of Fallot. Circulation 2013; 127:172-9. [DOI: 10.1161/circulationaha.112.129585] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- François-Pierre Mongeon
- From the Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec (F.-P.M., P.K.); Boston Adult Congenital Heart Service, Children’s Hospital Boston and Brigham and Women’s Hospital, Boston, MA (M.Z.G., A.R.O., A.M.V., M.J.L., P.K.); Oregon Health and Science University, Portland, OR (C.S.B.); Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); University of Colorado, Denver, CO (J.D.K.); Medical College of Wisconsin, Milwaukee, WI (M
| | - Michelle Z. Gurvitz
- From the Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec (F.-P.M., P.K.); Boston Adult Congenital Heart Service, Children’s Hospital Boston and Brigham and Women’s Hospital, Boston, MA (M.Z.G., A.R.O., A.M.V., M.J.L., P.K.); Oregon Health and Science University, Portland, OR (C.S.B.); Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); University of Colorado, Denver, CO (J.D.K.); Medical College of Wisconsin, Milwaukee, WI (M
| | - Craig S. Broberg
- From the Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec (F.-P.M., P.K.); Boston Adult Congenital Heart Service, Children’s Hospital Boston and Brigham and Women’s Hospital, Boston, MA (M.Z.G., A.R.O., A.M.V., M.J.L., P.K.); Oregon Health and Science University, Portland, OR (C.S.B.); Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); University of Colorado, Denver, CO (J.D.K.); Medical College of Wisconsin, Milwaukee, WI (M
| | - Jamil Aboulhosn
- From the Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec (F.-P.M., P.K.); Boston Adult Congenital Heart Service, Children’s Hospital Boston and Brigham and Women’s Hospital, Boston, MA (M.Z.G., A.R.O., A.M.V., M.J.L., P.K.); Oregon Health and Science University, Portland, OR (C.S.B.); Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); University of Colorado, Denver, CO (J.D.K.); Medical College of Wisconsin, Milwaukee, WI (M
| | - Alexander R. Opotowsky
- From the Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec (F.-P.M., P.K.); Boston Adult Congenital Heart Service, Children’s Hospital Boston and Brigham and Women’s Hospital, Boston, MA (M.Z.G., A.R.O., A.M.V., M.J.L., P.K.); Oregon Health and Science University, Portland, OR (C.S.B.); Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); University of Colorado, Denver, CO (J.D.K.); Medical College of Wisconsin, Milwaukee, WI (M
| | - Joseph D. Kay
- From the Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec (F.-P.M., P.K.); Boston Adult Congenital Heart Service, Children’s Hospital Boston and Brigham and Women’s Hospital, Boston, MA (M.Z.G., A.R.O., A.M.V., M.J.L., P.K.); Oregon Health and Science University, Portland, OR (C.S.B.); Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); University of Colorado, Denver, CO (J.D.K.); Medical College of Wisconsin, Milwaukee, WI (M
| | - Anne Marie Valente
- From the Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec (F.-P.M., P.K.); Boston Adult Congenital Heart Service, Children’s Hospital Boston and Brigham and Women’s Hospital, Boston, MA (M.Z.G., A.R.O., A.M.V., M.J.L., P.K.); Oregon Health and Science University, Portland, OR (C.S.B.); Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); University of Colorado, Denver, CO (J.D.K.); Medical College of Wisconsin, Milwaukee, WI (M
| | - Michael G. Earing
- From the Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec (F.-P.M., P.K.); Boston Adult Congenital Heart Service, Children’s Hospital Boston and Brigham and Women’s Hospital, Boston, MA (M.Z.G., A.R.O., A.M.V., M.J.L., P.K.); Oregon Health and Science University, Portland, OR (C.S.B.); Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); University of Colorado, Denver, CO (J.D.K.); Medical College of Wisconsin, Milwaukee, WI (M
| | - George K. Lui
- From the Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec (F.-P.M., P.K.); Boston Adult Congenital Heart Service, Children’s Hospital Boston and Brigham and Women’s Hospital, Boston, MA (M.Z.G., A.R.O., A.M.V., M.J.L., P.K.); Oregon Health and Science University, Portland, OR (C.S.B.); Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); University of Colorado, Denver, CO (J.D.K.); Medical College of Wisconsin, Milwaukee, WI (M
| | - Susan M. Fernandes
- From the Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec (F.-P.M., P.K.); Boston Adult Congenital Heart Service, Children’s Hospital Boston and Brigham and Women’s Hospital, Boston, MA (M.Z.G., A.R.O., A.M.V., M.J.L., P.K.); Oregon Health and Science University, Portland, OR (C.S.B.); Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); University of Colorado, Denver, CO (J.D.K.); Medical College of Wisconsin, Milwaukee, WI (M
| | - Deborah R. Gersony
- From the Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec (F.-P.M., P.K.); Boston Adult Congenital Heart Service, Children’s Hospital Boston and Brigham and Women’s Hospital, Boston, MA (M.Z.G., A.R.O., A.M.V., M.J.L., P.K.); Oregon Health and Science University, Portland, OR (C.S.B.); Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); University of Colorado, Denver, CO (J.D.K.); Medical College of Wisconsin, Milwaukee, WI (M
| | - Stephen C. Cook
- From the Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec (F.-P.M., P.K.); Boston Adult Congenital Heart Service, Children’s Hospital Boston and Brigham and Women’s Hospital, Boston, MA (M.Z.G., A.R.O., A.M.V., M.J.L., P.K.); Oregon Health and Science University, Portland, OR (C.S.B.); Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); University of Colorado, Denver, CO (J.D.K.); Medical College of Wisconsin, Milwaukee, WI (M
| | - Jennifer Grando Ting
- From the Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec (F.-P.M., P.K.); Boston Adult Congenital Heart Service, Children’s Hospital Boston and Brigham and Women’s Hospital, Boston, MA (M.Z.G., A.R.O., A.M.V., M.J.L., P.K.); Oregon Health and Science University, Portland, OR (C.S.B.); Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); University of Colorado, Denver, CO (J.D.K.); Medical College of Wisconsin, Milwaukee, WI (M
| | - Michelle J. Nickolaus
- From the Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec (F.-P.M., P.K.); Boston Adult Congenital Heart Service, Children’s Hospital Boston and Brigham and Women’s Hospital, Boston, MA (M.Z.G., A.R.O., A.M.V., M.J.L., P.K.); Oregon Health and Science University, Portland, OR (C.S.B.); Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); University of Colorado, Denver, CO (J.D.K.); Medical College of Wisconsin, Milwaukee, WI (M
| | - Michael J. Landzberg
- From the Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec (F.-P.M., P.K.); Boston Adult Congenital Heart Service, Children’s Hospital Boston and Brigham and Women’s Hospital, Boston, MA (M.Z.G., A.R.O., A.M.V., M.J.L., P.K.); Oregon Health and Science University, Portland, OR (C.S.B.); Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); University of Colorado, Denver, CO (J.D.K.); Medical College of Wisconsin, Milwaukee, WI (M
| | - Paul Khairy
- From the Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec (F.-P.M., P.K.); Boston Adult Congenital Heart Service, Children’s Hospital Boston and Brigham and Women’s Hospital, Boston, MA (M.Z.G., A.R.O., A.M.V., M.J.L., P.K.); Oregon Health and Science University, Portland, OR (C.S.B.); Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); University of Colorado, Denver, CO (J.D.K.); Medical College of Wisconsin, Milwaukee, WI (M
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Valve-sparing aortic root replacement in children. J Thorac Cardiovasc Surg 2012; 144:980-1. [DOI: 10.1016/j.jtcvs.2012.05.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 04/27/2012] [Accepted: 05/16/2012] [Indexed: 11/18/2022]
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Evaluation by MRA of aortic dilation late after repair of tetralogy of Fallot. Int J Cardiol 2012; 167:2922-7. [PMID: 22985743 DOI: 10.1016/j.ijcard.2012.07.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 07/12/2012] [Accepted: 07/21/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study evaluated predictors for aortic dilation (AD) in patients with repaired tetralogy of Fallot (rTOF) using magnetic resonance angiography (MRA). BACKGROUND AD is common in patients with rTOF and may result in increased morbidity and mortality. There are no guidelines for evaluation of AD for rTOF patients. METHODS All adults with rTOF who previously underwent MRA had retrospective aortic measurements at the sinuses of Valsalva (SoV) and ascending aorta (AsAo). Rate of change in diameter was determined in patients with multiple MRAs. Chart review identified risk factors for AD. Univariate and multivariate analyses tested predictors of AD. RESULTS Of the 87 patients who met the inclusion criteria, 12 (14%) had AD. At baseline, mean diameter was 3.6 ± 0.6 cm and 3.1 ± 0.6 cm at the SoV and AsAo, respectively. The AsAo was larger than the SoV in 17%. Predictors of AD included male gender, age, right aortic arch, pregnancy, older age at complete repair, smoking, and systemic hypertension. Serial studies were available in 55 patients; the rate of growth was slow: 0.4 ± 0.9 mm/year (SoV) and 0.1 ± 0.8mm/year (AsAo). CONCLUSIONS AD is common in rTOF at the SoV and AsAo. Transthoracic echocardiography, which does not always image the AsAo as well as MRA, may not image AD in rTOF in cases in which the AsAo is dilated. Although several risk factors correlate with AD in rTOF, the rate of aortic growth is slow, suggesting that rTOF patients may not require frequent aortic imaging.
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Rutz T, Max F, Wahl A, Wustmann K, Khattab K, Pfammatter JP, Kadner A, Schwerzmann M. Distensibility and diameter of ascending aorta assessed by cardiac magnetic resonance imaging in adults with tetralogy of fallot or complete transposition. Am J Cardiol 2012; 110:103-8. [PMID: 22459299 DOI: 10.1016/j.amjcard.2012.02.055] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 02/21/2012] [Accepted: 02/21/2012] [Indexed: 11/24/2022]
Abstract
Structural abnormalities of the medial aorta have been described for conotruncal defects (e.g., tetralogy of Fallot [TOF] and complete transposition of the great arteries (dextrotransposition [d]-TGA). In TOF, progressive aortic dilation is a frequent finding. In patients with d-TGA with an atrial switch, this problem is less often described. The aim of the present study was to compare the extent of dilative aortopathy and aortic distensibility in adults with an atrial switch procedure (n = 39) to that in adults with repaired TOF (n = 39) and controls (n = 39), using cardiac magnetic resonance imaging. The groups were matched for age and gender. Diameters of the aorta indexed to the body surface area were significantly increased in the patients with d-TGA and TOF compared to that of the controls at the aortic sinus up to the level of the right pulmonary artery. On multivariate testing, the diagnosis of a conotruncal defect (β = 0.260; p = 0.003) and aortic regurgitant fraction (β = 0.405; p <0.001) were independent predictors of an increased aortic sinus diameter. Ascending aorta distensibility was significantly reduced in those with d-TGA and TOF compared to controls: 3.6 (interquartile range 1.5 to 4.4) versus 2.8 (interquartile range 2.0 to 3.7) versus 5.5 (interquartile range 4.8 to 6.9) ×10(-3) mm Hg(-1) (p <0.001). The independent predictors of ascending aorta distensibility were the diagnosis of a conotruncal defect (p <0.001) and age (p = 0.028). In conclusion, intrinsic aortopathy, manifested as increased ascending aortic diameters and reduced ascending aortic distensibility, is not only evident in adults with TOF, but also in adults with d-TGA and an atrial switch procedure. Long-term follow-up is needed to monitor the aortic size in both patient groups.
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