Follow-up aortic dilatation in patients with repaired tetralogy of Fallot using cardiovascular magnetic resonance

Suvipaporn Siripornpitak; Apichaya Sriprachyakul; Saruntorn Wongmetta; Piya Samankatiwat; Pirapat Mokarapong; Suthep Wanitkun

doi:10.1016/j.ejro.2021.100354

Follow-up aortic dilatation in patients with repaired tetralogy of Fallot using cardiovascular magnetic resonance

Eur J Radiol Open. 2021 May 12:8:100354. doi: 10.1016/j.ejro.2021.100354. eCollection 2021.

Authors

Suvipaporn Siripornpitak¹, Apichaya Sriprachyakul¹, Saruntorn Wongmetta¹, Piya Samankatiwat², Pirapat Mokarapong³, Suthep Wanitkun⁴

Affiliations

¹ Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand.
² Division of Thoracic Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand.
³ Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Institute of Cardiovascular Diseases, Rajavithi Hospital, 2 Phayatai Road, Ratchathewi, Bangkok, 10400, Thailand.
⁴ Division of Cardiology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand.

Abstract

Purpose: The study sought to determine the rate of aortic expansion and correlation with somatic growth in patients with repaired tetralogy of Fallot (rTOF), and predictors for determining the annual growth rate of the aorta (Ao-AGR).

Methods: Ninety-four rTOF patients (mean age 14.5 ± 4.4 years) with two cardiac magnetic resonance tests (CMR) (median duration 52 months, interquartile range, IQR 24-71) were analyzed for aortic diameter (AoD) at the annulus, the sinus of Valsalva (SoV), the sinotubular junction, and the ascending aorta (AAo), and compared with the normal limit AoD (NL-AoD) values. The median age-at-repair was 60 months (IQR 36-84). Ao-AGR and its index (Ao-AGRI) were derived from changes of the AoD and AoD-index, respectively, divided by the duration between the two studies. Three potential predictors (baseline AoD, sex, and age-at-repair) for the progression of Ao-AGR were analyzed.

Results: There was a significant larger AoD than NL-AoD (p < 0.001). Slow aortic growth was encountered in 78-85 % of patients. The Ao-AGR was slow, the median AGR ranged from 0.37 mm (IQR 0.13-0.72) at annulus to 0.56 mm (IQR 0.22-0.91) at AAo. There was a regression in Ao-AGRI, ranged from -1.41 mm (IQR -1.94, -0.87) at annulus to -2.36 mm (IQR -3.09, -1.63) at SoV. The three predictors were not correlated with severity of Ao-AGR.

Conclusion: Most adolescents with rTOF show significant aortic dilatation. There is a slow Ao-AGR with regression of Ao-AGRI, which may suggest that the rate of aortic growth is slower than the somatic growth. There are no significant predictors of the progression of Ao-AGR.

Keywords: AAo, ascending aorta; AGR, annual growth rate; Annual growth rate; Annual growth rate index; Ao-AGR, annual growth rate of the aorta; AoD, aortic diameter; AoR, aortic root; Aortic diameter; Aortic diameter index; CMR, cardiac magnetic resonance; Repaired tetralogy of Fallot; STJ, sinotubular junction; SoV, sinus of Valsalva; Somatic growth; TOF, tetralogy of Fallot; cine bSSFP, cine balanced steady-state free precession; rTOF, repaired tetralogy of Fallot.