Open Access

ARTICLE

Prospective Cohort Research of Aortic Root Dilatation after Surgical Repair in Adults with Tetralogy of Fallot (TRANSIT)

by Hiroki Nagamine¹, Masaru Miura^1,*, Jun Maeda¹, Takumi Nishiki¹, Maasa Sato², Fumie Takechi³, Shigeru Tateno⁴, Tomoko Ishizu⁵, Yumi Shiina⁶, Ken Kato⁷, Hiroshi Ono⁸, Hiroyuki Yamagishi⁹, Koichiro Niwa⁶

1 Department of Cardiology, Tokyo Metropolitan Children’s Medical Center, Tokyo, 183-8561, Japan
2 Department of Pediatric Cardiology, Sakakibara Heart Institute, Tokyo, 183-0003, Japan
3 Department of Adult Congenital Heart Disease, Chiba Cerebral and Cardiovascular Center, Chiba, 305-8576, Japan
4 Department of Adult Congenital Heart Disease, Chiba Kaihin Municipal Hospital, Chiba, 261-0003, Japan
5 Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, 305-8576, Japan
6 Cardiovascular Center, St. Luke’s International Hospital, Tokyo, 104-8560, Japan
7 Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, 183-8524, Japan
8 Division of Cardiology, National Center for Child Health and Development, Tokyo, 158-8531, Japan
9 Center for Preventive Medicine, Keio University School of Medicine, Tokyo, 160-0016, Japan

* Corresponding Author: Masaru Miura. Email:

Congenital Heart Disease 2024, 19(4), 351-362. https://doi.org/10.32604/chd.2024.051837

Received 16 March 2024; Accepted 03 June 2024; Issue published 31 October 2024

Abstract

Background: Aortic root dilatation occurs in adults with tetralogy of Fallot (TOF) after surgical repair, but the longitudinal changes are unclear. The main research aim is to determine the annual dilatation rate of aorta in adults with repaired TOF. Methods: The present, multicentric, prospective cohort study assessed the rate of aortic diameter change in adults aged 20 years or older with TOF, including pulmonary artery atresia, who underwent surgical repair. Clinical data, focusing on echocardiograms, were collected at three-year intervals from seven hospitals. Results: In total, 104 patients (58 males; median age: 29 years) were enrolled. The actual Valsalva sinus (VS) diameter was 34.3 ± 5.8 (mean ± standard deviation) and 36.1 ± 6.0 mm at the initial and final examinations, respectively, and the annual dilatation rate was 0.64 (0.07, 1.33) (median, interquartile) mm/year. The corrected diameter at the respective examination was 21.3 ± 3.8 and 22.2 ± 3.7 mm/m², and the annual dilation rate was 0.28 (−0.21, 0.76) mm/m²/year. Multiple regression analysis showed that factors significant associated with dilatation rate of actual VS diameter were the diastolic blood pressure (standardized coefficient −0.22; p = 0.04), cardiothoracic ratio (0.28; 0.02), and the ratio of early mitral valve inflow velocity to early diastolic annular velocity (E/e′) ratio (0.31; 0.004). Factors significantly associated with corrected VS diameter were diastolic blood pressure (−0.25; 0.02) and the E/e′ ratio (0.34; 0.001). Conclusions: In adults with repaired TOF, the rate of dilatation of the aortic diameter was associated with decreased diastolic blood pressure and left ventricular diastolic dysfunction, possibly reflecting decreased aortic wall elasticity.

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