Aortic regurgitation in adults after surgical repair of tetralogy of Fallot.

BACKGROUND

Total surgical repair of tetralogy of Fallot is usually associated with a favourable long-term outcome. However, complications or consequences of the defect such as dilatation of aortic root and aortic regurgitation are present in some patients.

AIM

To assess the prevalence of aortic regurgitation in relation to the timing of surgery and preceding palliative procedures as well as to examine its effects on left ventricular (LV) dimensions in adults after surgical repair of tetralogy of Fallot.

METHODS

The study group consisted of 63 patients in the mean age of 25.6+/-6.5 years who underwent surgery at the mean age of 7.4 years (mean 17.2 years ago). Echocardiographic assessment of the thickness of the inter-ventricular septum, posterior LV wall, end-diastolic LV diameter, left atrial dimension and aortic root diameter was performed. Aortic incompetence was examined using a colour Doppler method.

RESULTS

Aortic incompetence was found in 13 (20%) patients. Only four of them had undergone a palliative procedure prior to the repair of the defect. Patients with aortic regurgitation had significantly greater aortic root dimension (p=0.001), LV diameter (p=0.05) and were significantly older (p=0.005) than patients without aortic incompetence. A significant correlation was found between aortic root diameter and current age (p=0.02). A significant correlation was also observed between LV diameter and time elapsed after surgery (p=0.001), and between left atrial dimension and patients' current age (p=0.02) as well as time from the repair of the defect (p=0.003).

CONCLUSIONS

1. Minor aortic regurgitation and LV dilatation are present in 20% of adults who underwent repair of tetralogy of Fallot. 2. Aortic regurgitation is present in those who have dilated aortic root. 3. Aortic regurgitation is not associated with palliative surgery performed in the past. 4. Aortic regurgitation is more frequent in the elderly but is not associated with patient's age at surgery or time elapsed since repair.