Department of Cardiac Surgery, The Cardiac Centre, University Hospital Gent, Gent, Belgium.
Eur J Cardiothorac Surg. 2010 Jun;37(6):1254-8. doi: 10.1016/j.ejcts.2009.12.019. Epub 2010 Feb 4.
Late aortic root dilatation is a growing concern in patients operated on for tetralogy of Fallot (ToF). This longitudinal follow-up study sought to evaluate the changes in the aortic root dimensions in relation to body growth, assuming that early repair of tetralogy of Fallot might prevent late aortic dilatation.
A retrospective analysis of the aortic root dimensions was performed in 88 patients repaired early for tetralogy of Fallot by echocardiographic measurement of aortic annulus, sinus of Valsalva and sinotubular junction, adjusted for body surface area and expressed as z-scores. Mean age at repair was 9.7 + or - 7.4 months. Median age was 7.3 months (range 45 days-29 months).
At the time of repair, all root dimensions were enlarged: z-score of the annulus 3.32 + or - 1.66; sinus 3.54 + or - 1.49; sinotubular junction 2.74 + or - 1.19. Within a mean follow-up of 6.9 + or - 4.4 years, the mean z-scores of both annulus and sinotubular junction significantly decreased to normal size at 7 years postoperatively: z-score of annulus 0.95 + or - 0.7 (p=0.006), z-score of sinotubular junction 0.99 + or - 1.47 (p=0.006). The z-score of the aortic sinuses appeared to regress slower to 2.78 + or - 1.26 (p=0.262). The indexed sinus diameter however regressed significantly from a mean of 51.4 + or - 13.4 mmm(-2) at correction to 28.9 + or - 7.2 mmm(-2) (p=0.0001) at latest follow-up. Evolution of aortic root size after repair was independent of aortic arch side, sex, age at repair or previous shunt palliation.
The initially dilated aortic root in tetralogy of Fallot normalises in size at the level of the annulus and sinotubular junction within 7 years after early repair. This process seems delayed at the level of the aortic sinuses, although the indexed root diameter shows significant regression over time. These results suggest that early repair of ToF abrogates the enlargement of the aortic root, validating one aspect of the need for tetralogy correction at a young age.
晚期主动脉根部扩张是法洛四联症（ToF）患者的一个日益关注的问题。这项纵向随访研究旨在评估主动脉根部尺寸的变化与身体生长的关系，假设早期修复法洛四联症可能预防晚期主动脉扩张。
通过超声心动图测量主动脉瓣环、主动脉窦和窦管交界的面积，对 88 例早期接受法洛四联症修复的患者的主动脉根部尺寸进行回顾性分析，并按体表面积进行校正，用 z 评分表示。修复时的平均年龄为 9.7 ± 7.4 个月。中位数年龄为 7.3 个月（范围 45 天至 29 个月）。
在修复时，所有根部尺寸均增大：瓣环 z 评分 3.32 ± 1.66；窦 z 评分 3.54 ± 1.49；窦管交界 z 评分 2.74 ± 1.19。在平均 6.9 ± 4.4 年的随访中，瓣环和窦管交界的平均 z 评分在术后 7 年降至正常大小：瓣环 z 评分 0.95 ± 0.7（p=0.006），窦管交界 z 评分 0.99 ± 1.47（p=0.006）。主动脉窦的 z 评分似乎恢复较慢，至 2.78 ± 1.26（p=0.262）。然而，在最新的随访中，窦内径的指数从矫正时的平均 51.4 ± 13.4 mmm(-2)显著降低至 28.9 ± 7.2 mmm(-2)（p=0.0001）。修复后主动脉根部大小的演变与主动脉弓侧、性别、修复时年龄或先前分流姑息治疗无关。
在早期修复后 7 年内，法洛四联症中扩张的主动脉根部在瓣环和窦管交界水平恢复正常大小。在主动脉窦水平，这一过程似乎较慢，尽管随着时间的推移，根部直径的指数有显著的下降。这些结果表明，早期修复法洛四联症可消除主动脉根部的扩大，验证了在年轻时进行四联症矫正的必要性的一个方面。
