Kawasaki Yuki, Takajo Daiji, Gupta Pooja, Aggarwal Sanjeev
Department of Pediatric Cardiology, Osaka City General Hospital Pediatric Medical Center, Osaka, Japan.
Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA.
Cardiol Young. 2024 Nov;34(11):2290-2295. doi: 10.1017/S1047951124026842. Epub 2024 Oct 23.
Aortic root dilation has been reported commonly after repair of tetralogy of Fallot. However, the rate and risk factors of progression of the dilation are not fully understood. This is a single-centre, retrospective study to assess the rate and factors associated with progressive dilatation of the aortic root in repaired tetralogy of Fallot patients using cardiac MRI. The presence of the significant aortic dilation and the progression of dilation between initial and follow-up cardiac MRI were examined. The study cohort comprised 72 patients with repaired tetralogy of Fallot. The median age at the initial cardiac MRI scan was 19.6 (interquartile range: 14.6-31) years, and the median follow-up interval was 4.3 (2.9-5.7) years. Median dimension of ascending aorta at initial and follow-up cardiac MRI was 27.0 (22.3-31.0) mm and 29.2 (25.0-32.1) mm, respectively. Significant aortic dilation (the percentage predicted ascending aorta ≥150%) was observed in 11 (15.2%) patients at the initial cardiac MRI and 24 (33.3%) at the follow-up cardiac MRI. The significant aortic dilation at follow-up cardiac MRI was associated with increased indexed left ventricular stroke volume (odds ratio 1.062, = 0.023). Thirteen patients demonstrated the significant progressive dilation of aorta between initial and follow-up cardiac MRI. The progressive dilation was associated with left ventricular ejection fraction at initial cardiac MRI (odds ratio 1.135, = 0.048). In patients with repaired tetralogy of Fallot, aortic dilation is common and progresses over time. Cardiac MRI is a valuable tool for identifying individuals at risk for progressive aortic dilation.
法洛四联症修复术后主动脉根部扩张较为常见。然而，扩张进展的速率及危险因素尚未完全明确。本研究为单中心回顾性研究，旨在利用心脏磁共振成像（MRI）评估法洛四联症修复术后患者主动脉根部进行性扩张的速率及相关因素。检查了初次及随访心脏MRI时显著主动脉扩张的存在情况以及扩张进展情况。研究队列包括72例法洛四联症修复术后患者。初次心脏MRI扫描时的中位年龄为19.6岁（四分位间距：14.6 - 31岁），中位随访间隔为4.3年（2.9 - 5.7年）。初次及随访心脏MRI时升主动脉的中位直径分别为27.0（22.3 - 31.0）mm和29.2（25.0 - 32.1）mm。初次心脏MRI时11例（15.2%）患者存在显著主动脉扩张（预测升主动脉百分比≥150%），随访心脏MRI时为24例（33.3%）。随访心脏MRI时的显著主动脉扩张与左心室指数每搏输出量增加相关（比值比1.062，P = 0.023）。13例患者在初次及随访心脏MRI之间出现主动脉显著进行性扩张。进行性扩张与初次心脏MRI时的左心室射血分数相关（比值比1.135，P = 0.048）。在法洛四联症修复术后患者中，主动脉扩张常见且随时间进展。心脏MRI是识别有主动脉进行性扩张风险个体的重要工具。
