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(Circulation. 2002;106:1310.)
© 2002 American Heart Association, Inc.

Editorial

Aortic Root Dilatation After Repair of Tetralogy of Fallot

Pathology From the Past?

Carole A. Warnes, MD, MRCP; John S. Child, MD

From the Division of Cardiovascular Diseases and Internal Medicine (C.A.W.), Mayo Clinic, Rochester, Minn; and Ahmanson/UCLA Adult Congenital Heart Disease Center (J.S.C.), University of California Los Angeles Medical Center, Los Angeles, Calif.

Correspondence to Carole A. Warnes, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail warnes.carole@mayo.edu

Key Words: Editorials • tetralogy of Fallot • aneurysm • aorta • heart defects, congenital

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Repair of tetralogy of Fallot (TOF) has been performed since 1954¹ and adult survival is expected.² Long-term problems include arrhythmias, both supraventricular and ventricular, and residual hemodynamic problems, which are generally well tolerated for many years; these include residual ventricular septal defect and pulmonary stenosis but, most commonly, pulmonary regurgitation, with its consequent right ventricular dysfunction and tricuspid regurgitation. Although the most common reason for repeat surgery in the adult after TOF repair relates to problems in the right ventricular outflow tract, the aortic root is often forgotten. In this issue of Circulation, Niwa et al³ report a series of 32 patients who demonstrated a dilated aortic root after surgical repair of tetralogy of Fallot (TOF). Aortic root size measured echocardiographically was >1.5 expected diameter by standard nomogram. This "dilator" group comprised almost 15% of their TOF patient population. Characteristics of these patients with TOF compared with age-matched controls included a higher prevalence of pulmonary atresia, a longer shunt-to-repair interval, and a right aortic arch. Other features were consequent on the dilated aorta rather than causal, moderate-to-severe aortic regurgitation and a larger left ventricle both echocardiographically and radiographically. Two of these patients needed aortic valve replacement and root repair.

See p 1374

These observations are not new. Progressive aortic root dilatation after complete uncomplicated repair of TOF has been noted previously,⁴ and others have reported aortic regurgitation.^5–7 In the majority of patients, however, the aortic regurgitation is mild and of little or no clinical consequence.^6,7 In the Mayo Clinic . . . [Full Text of this Article]

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