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Erschienen in: The International Journal of Cardiovascular Imaging 8/2016

30.05.2016 | Original Paper

Dilatation of the ascending aorta is associated with presence of aortic regurgitation in patients after repair of tetralogy of Fallot

verfasst von: Karen Gomes Ordovas, Alexander Keedy, David M. Naeger, Kimberly Kallianos, Elyse Foster, Jing Liu, David Saloner, Michael D. Hope

Erschienen in: The International Journal of Cardiovascular Imaging | Ausgabe 8/2016

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Abstract

To evaluate the association between aortic morphology and elasticity with aortic regurgitation in surgically corrected of tetralogy of Fallot (TOF) patients. We retrospectively identified 72 consecutive patients with surgically corrected TOF and 27 healthy controls who underwent cardiac MRI evaluation. Velocity-encoded cine MRI was used to quantify degree of aortic regurgitation (AR) in TOF patients. Ascending aorta diameters were measured at standard levels on MRA images. Aortic pulse-wave velocity (PWV) was quantified with MRI. Morphological and functional MRI variables were compared between groups of TOF patients with and without clinically relevant AR and controls. The association between aortic morphology and elasticity with the presence of AR was evaluated using univariate and multivariate logistic regression. The majority of TOF patients had only trace AR. Nine TOF patients (12 %) had an AR fraction higher than 15 %. Indexed aorta diameter at the sinotubular junction (p = 0.007), at the RPA level (p = 0.006), and low left ventricular ejection fraction (LVEF) (p = 0.015) showed the strongest associations with the presence of at least mild AR, which persisted after controlling for age and gender. Increased ascending aorta dimension is associated with AR in patients after repair of TOF. LVEF was also low in the group of patients with relevant AR compared to those without, suggesting even mild to moderate AR may contribute to LV dysfunction in these patients. Enlarged ascending aorta may be an indication for precise quantification of regurgitant fraction with MRI, since symptomatic patients may need aortic valve repair when moderate regurgitation is present.
Literatur
1.
Zurück zum Zitat Murphy JG, Gersh BJ, Mair DD et al (1993) Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. N Engl J Med 329(9):593–599CrossRefPubMed Murphy JG, Gersh BJ, Mair DD et al (1993) Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. N Engl J Med 329(9):593–599CrossRefPubMed
2.
Zurück zum Zitat Nollert G, Fischlein T, Bouterwek S, Bohmer C, Klinner W, Reichart B (1997) Long-term survival in patients with repair of tetralogy of Fallot: 36-year follow-up of 490 survivors of the first year after surgical repair. J Am Coll Cardiol 30(5):1374–1383CrossRefPubMed Nollert G, Fischlein T, Bouterwek S, Bohmer C, Klinner W, Reichart B (1997) Long-term survival in patients with repair of tetralogy of Fallot: 36-year follow-up of 490 survivors of the first year after surgical repair. J Am Coll Cardiol 30(5):1374–1383CrossRefPubMed
3.
Zurück zum Zitat Deanfield JE, Ho SY, Anderson RH, McKenna WJ, Allwork SP, Hallidie-Smith KA (1983) Late sudden death after repair of tetralogy of Fallot: a clinicopathologic study. Circulation 67(3):626–631CrossRefPubMed Deanfield JE, Ho SY, Anderson RH, McKenna WJ, Allwork SP, Hallidie-Smith KA (1983) Late sudden death after repair of tetralogy of Fallot: a clinicopathologic study. Circulation 67(3):626–631CrossRefPubMed
4.
Zurück zum Zitat Niwa K (2005) Aortic root dilatation in tetralogy of Fallot long-term after repair—histology of the aorta in tetralogy of Fallot: evidence of intrinsic aortopathy. Int J Cardiol 103(2):117–119CrossRefPubMed Niwa K (2005) Aortic root dilatation in tetralogy of Fallot long-term after repair—histology of the aorta in tetralogy of Fallot: evidence of intrinsic aortopathy. Int J Cardiol 103(2):117–119CrossRefPubMed
5.
Zurück zum Zitat Niwa K, Perloff JK, Bhuta SM et al (2001) Structural abnormalities of great arterial walls in congenital heart disease: light and electron microscopic analyses. Circulation 103(3):393–400CrossRefPubMed Niwa K, Perloff JK, Bhuta SM et al (2001) Structural abnormalities of great arterial walls in congenital heart disease: light and electron microscopic analyses. Circulation 103(3):393–400CrossRefPubMed
6.
Zurück zum Zitat Tan JL, Davlouros PA, McCarthy KP, Gatzoulis MA, Ho SY (2005) Intrinsic histological abnormalities of aortic root and ascending aorta in tetralogy of Fallot: evidence of causative mechanism for aortic dilatation and aortopathy. Circulation 112(7):961–968CrossRefPubMed Tan JL, Davlouros PA, McCarthy KP, Gatzoulis MA, Ho SY (2005) Intrinsic histological abnormalities of aortic root and ascending aorta in tetralogy of Fallot: evidence of causative mechanism for aortic dilatation and aortopathy. Circulation 112(7):961–968CrossRefPubMed
7.
Zurück zum Zitat Niwa K, Siu SC, Webb GD, Gatzoulis MA (2002) Progressive aortic root dilatation in adults late after repair of tetralogy of Fallot. Circulation 106(11):1374–1378CrossRefPubMed Niwa K, Siu SC, Webb GD, Gatzoulis MA (2002) Progressive aortic root dilatation in adults late after repair of tetralogy of Fallot. Circulation 106(11):1374–1378CrossRefPubMed
8.
Zurück zum Zitat Kim WH, Seo JW, Kim SJ, Song J, Lee J, Na CY (2005) Aortic dissection late after repair of tetralogy of Fallot. Int J Cardiol 101(3):515–516CrossRefPubMed Kim WH, Seo JW, Kim SJ, Song J, Lee J, Na CY (2005) Aortic dissection late after repair of tetralogy of Fallot. Int J Cardiol 101(3):515–516CrossRefPubMed
9.
Zurück zum Zitat Rathi VK, Doyle M, Williams RB, Yamrozik J, Shannon RP, Biederman RW (2005) Massive aortic aneurysm and dissection in repaired tetralogy of Fallot; diagnosis by cardiovascular magnetic resonance imaging. Int J Cardiol 101(1):169–170CrossRefPubMed Rathi VK, Doyle M, Williams RB, Yamrozik J, Shannon RP, Biederman RW (2005) Massive aortic aneurysm and dissection in repaired tetralogy of Fallot; diagnosis by cardiovascular magnetic resonance imaging. Int J Cardiol 101(1):169–170CrossRefPubMed
10.
Zurück zum Zitat Capelli H, Ross D, Somerville J (1982) Aortic regurgitation in tetrad of Fallot and pulmonary atresia. Am J Cardiol 49(8):1979–1983CrossRefPubMed Capelli H, Ross D, Somerville J (1982) Aortic regurgitation in tetrad of Fallot and pulmonary atresia. Am J Cardiol 49(8):1979–1983CrossRefPubMed
11.
Zurück zum Zitat Geva T, Sandweiss BM, Gauvreau K, Lock JE, Powell AJ (2004) Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. J Am Coll Cardiol 43(6):1068–1074CrossRefPubMed Geva T, Sandweiss BM, Gauvreau K, Lock JE, Powell AJ (2004) Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. J Am Coll Cardiol 43(6):1068–1074CrossRefPubMed
12.
Zurück zum Zitat Ishizaka T, Ichikawa H, Sawa Y et al (2004) Prevalence and optimal management strategy for aortic regurgitation in tetralogy of Fallot. Eur J Cardiothorac Surg 26(6):1080–1086CrossRefPubMed Ishizaka T, Ichikawa H, Sawa Y et al (2004) Prevalence and optimal management strategy for aortic regurgitation in tetralogy of Fallot. Eur J Cardiothorac Surg 26(6):1080–1086CrossRefPubMed
13.
Zurück zum Zitat Geva T (2011) Repaired tetralogy of Fallot: the roles of cardiovascular magnetic resonance in evaluating pathophysiology and for pulmonary valve replacement decision support. J Cardiovasc Magn Reson 13:9CrossRefPubMedPubMedCentral Geva T (2011) Repaired tetralogy of Fallot: the roles of cardiovascular magnetic resonance in evaluating pathophysiology and for pulmonary valve replacement decision support. J Cardiovasc Magn Reson 13:9CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Valente AM, Cook S, Festa P et al (2014) Multimodality imaging guidelines for patients with repaired tetralogy of fallot: a report from the American Society of Echocardiography: developed in collaboration with the Society for Cardiovascular Magnetic Resonance and the Society for Pediatric Radiology. J Am Soc Echocardiogr 27(2):111–141CrossRefPubMed Valente AM, Cook S, Festa P et al (2014) Multimodality imaging guidelines for patients with repaired tetralogy of fallot: a report from the American Society of Echocardiography: developed in collaboration with the Society for Cardiovascular Magnetic Resonance and the Society for Pediatric Radiology. J Am Soc Echocardiogr 27(2):111–141CrossRefPubMed
15.
Zurück zum Zitat Nishimura RA, Otto CM, Bonow RO et al (2014) AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg 2014;148(1):e1–e132CrossRef Nishimura RA, Otto CM, Bonow RO et al (2014) AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg 2014;148(1):e1–e132CrossRef
16.
Zurück zum Zitat Heiberg E, Sjogren J, Ugander M, Carlsson M, Engblom H, Arheden H (2010) Design and validation of Segment—freely available software for cardiovascular image analysis. BMC Med Imaging 10:1CrossRefPubMedPubMedCentral Heiberg E, Sjogren J, Ugander M, Carlsson M, Engblom H, Arheden H (2010) Design and validation of Segment—freely available software for cardiovascular image analysis. BMC Med Imaging 10:1CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat van Elderen SG, Westenberg JJ, Brandts A et al (2011) Increased aortic stiffness measured by MRI in patients with type 1 diabetes mellitus and relationship to renal function. Am J Roentgenol 196(3):697–701CrossRef van Elderen SG, Westenberg JJ, Brandts A et al (2011) Increased aortic stiffness measured by MRI in patients with type 1 diabetes mellitus and relationship to renal function. Am J Roentgenol 196(3):697–701CrossRef
18.
Zurück zum Zitat Ibrahim el SH, Johnson KR, Miller AB, Shaffer JM, White RD (2010) Measuring aortic pulse wave velocity using high-field cardiovascular magnetic resonance: comparison of techniques. J Cardiovasc Magn Reson 12(1):26CrossRef Ibrahim el SH, Johnson KR, Miller AB, Shaffer JM, White RD (2010) Measuring aortic pulse wave velocity using high-field cardiovascular magnetic resonance: comparison of techniques. J Cardiovasc Magn Reson 12(1):26CrossRef
19.
Zurück zum Zitat Grothoff M, Mende M, Graefe D et al (2016) Dimensions of the ascending aorta in children and adolescents with repaired tetralogy of Fallot obtained by cardiac magnetic resonance angiography. Clin Res Cardiol 105(3):239–247CrossRefPubMed Grothoff M, Mende M, Graefe D et al (2016) Dimensions of the ascending aorta in children and adolescents with repaired tetralogy of Fallot obtained by cardiac magnetic resonance angiography. Clin Res Cardiol 105(3):239–247CrossRefPubMed
20.
Zurück zum Zitat Dearani JA, Burkhart HM, Stulak JM, Sundt TM, Schaff HV (2009) Management of the aortic root in adult patients with conotruncal anomalies.In: Seminars in thoracic cardiovascular Surgery: pediatric cardiac surgery annual, pp 122–129 Dearani JA, Burkhart HM, Stulak JM, Sundt TM, Schaff HV (2009) Management of the aortic root in adult patients with conotruncal anomalies.In: Seminars in thoracic cardiovascular Surgery: pediatric cardiac surgery annual, pp 122–129
22.
Zurück zum Zitat Muzzarelli S, Ordovas KG, Cannavale G, Meadows AK, Higgins CB (2011) Tetralogy of Fallot: impact of the excursion of the interventricular septum on left ventricular systolic function and fibrosis after surgical repair. Radiology 259(2):375–383CrossRefPubMed Muzzarelli S, Ordovas KG, Cannavale G, Meadows AK, Higgins CB (2011) Tetralogy of Fallot: impact of the excursion of the interventricular septum on left ventricular systolic function and fibrosis after surgical repair. Radiology 259(2):375–383CrossRefPubMed
23.
Zurück zum Zitat Senzaki H, Iwamoto Y, Ishido H et al (2008) Arterial haemodynamics in patients after repair of tetralogy of Fallot: influence on left ventricular after load and aortic dilatation. Heart 94(1):70–74CrossRefPubMed Senzaki H, Iwamoto Y, Ishido H et al (2008) Arterial haemodynamics in patients after repair of tetralogy of Fallot: influence on left ventricular after load and aortic dilatation. Heart 94(1):70–74CrossRefPubMed
24.
Zurück zum Zitat Grotenhuis HB, Ottenkamp J, de Bruijn L et al (2009) Aortic elasticity and size are associated with aortic regurgitation and left ventricular dysfunction in tetralogy of Fallot after pulmonary valve replacement. Heart 95(23):1931–1936CrossRefPubMed Grotenhuis HB, Ottenkamp J, de Bruijn L et al (2009) Aortic elasticity and size are associated with aortic regurgitation and left ventricular dysfunction in tetralogy of Fallot after pulmonary valve replacement. Heart 95(23):1931–1936CrossRefPubMed
Metadaten
Titel
Dilatation of the ascending aorta is associated with presence of aortic regurgitation in patients after repair of tetralogy of Fallot
verfasst von
Karen Gomes Ordovas
Alexander Keedy
David M. Naeger
Kimberly Kallianos
Elyse Foster
Jing Liu
David Saloner
Michael D. Hope
Publikationsdatum
30.05.2016
Verlag
Springer Netherlands
Erschienen in
The International Journal of Cardiovascular Imaging / Ausgabe 8/2016
Print ISSN: 1569-5794
Elektronische ISSN: 1875-8312
DOI
https://doi.org/10.1007/s10554-016-0902-4

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