Progressive Aortic Root Dilatation in Adults Late After Repair of Tetralogy of Fallot

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Abstract
Background— Aortic valve or aortic root (AoRo) replacement is occasionally required because of AoRo dilatation and aortic regurgitation (AR) in repaired tetralogy of Fallot (TOF). We evaluated AoRo size and possible factors associated with its dynamic nature in adults with repaired TOF. Methods and Results— Of 216 patients with TOF repair who underwent echocardiography in 1997, we identified 32 patients (mean age, 36±8.0 years) with AoRo dilatation, defined as ratio of observed to expected AoRo size by standard nomogram >1.5 (group A), and 54 TOF controls, matched for age with AoRo ratio 2 ) in 1997 was 2.5±0.5 in group A and 1.7±0.2 in group B ( P P =0.001). Patients from group A had a longer shunt-to-repair interval ( P =0.048) with a higher prevalence of pulmonary atresia ( P P =0.03), moderate to severe AR ( P =0.002), aortic valve replacement ( P =0.02), larger cardiothoracic ratio ( P =0.02), and increased left ventricular end-diastolic dimensions ( P =0.002). Conclusions— A subset of adult TOF exhibits ongoing dilatation of AoRo late after repair. This dilatation relates to previous long-standing volume overload of AoRo and possibly to intrinsic properties of AoRo and may lead to AR. Meticulous follow-up of AoRo after TOF repair is recommended.