Histopathologic changes in ascending aorta and risk factors related to histopathologic conditions and aortic dilatation in patients with tetralogy of Fallot

Backgrounds: Dilatation of aortic root or ascending aorta is often seen in the patients with conotruncal anomalies (CA). How fast these structures dilate and how we manage this phenomenon are not clear. Methods: We reviewed medical records of patients who underwent biventricular repair of CA such as tetralogy of Fallot (TOF), double outlet right ventricle (DORV) and truncus arteriosus (TA) from 2004 to 2018. We included 99 patients who had follow-up cardiac computed tomography angiography (CT) images at least 5 years since initial CT in this study. We analyzed changes of diameters of aortic root structures and ascending aorta between initial and follow-up CT images. Results: Median follow-up duration was 16.1 years (interquartile range (IQR): 11.8~26.2 years) after operation. Median interval between initial and follow-up CT examination was 9.4 years (IQR: 7.1~11.5 years). Median age of initial and follow-up CT was 4.3 years (IQR: 0.3~12.3 years) and 14.4 years (IQR: 9.2~22.9 years). The median z-scores (with IQR) of sinus of Valsalva (SV, 2.0 (0.8~3.3) → 2.4 (1.4~3.3), p=0.006) and sinotubular junction (STJ, 1.3 (-0.2~2.6) → 2.2 (0.4~3.3), p=0.001) were significantly changed, whereas aortic annulus (AA, 2.4 (0.9~3.4) → 2.3 (0.8~3.3), p=0.21) and ascending aorta (AsA, 1.6 (0.4~2.9) → 1.6 (0.03~2.6), p=0.27) did not show significant changes in CT images. Median increasing rate of diameter of AA, SV, STJ and AsA was 0.72, 0.93, 0.83 and 0.51 mm/year, respectively. Dilatation rate of AA (0.69 in TOF vs. 0.99 in TA, p=0.042) and SV (0.81 in TOF vs. 1.53 in TA, p=0.008) of TA was significantly higher than of TOF. Conclusions: In TOF, DORV and TA, SV and STJ significantly dilated, whereas AsA and AA did not significantly dilated for 9 years of follow-up. Although chance of surgical intervention for dilatation of aortic structures was rare, it might be necessary to observe closely aortic valvular function associated with structural deterioration of SV or STJ.

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Prevalence and progression of aortic dilatation in adult patients with Turner syndrome: a cohort study

Acta Endocrinologica ◽

10.1530/eje-20-0284 ◽

2020 ◽

Vol 183 (4) ◽

pp. 463-470 ◽

Cited By ~ 1

Author(s):

Bruno Donadille ◽

Sophie Tuffet ◽

Clement Cholet ◽

Mariana Nedelcu ◽

Nathalie Bourcigaux ◽

...

Keyword(s):

Risk Factors ◽

Turner Syndrome ◽

Ascending Aorta ◽

Adult Patients ◽

Growth Potential ◽

Aortic Dilatation ◽

Root Growth Potential ◽

Potential Risk Factors ◽

Mri Protocol

Objective: Turner syndrome (TS) is a rare disorder affecting 1/2500 female newborn. Aortic dilatation (AD) and aortic dissection represent a major concern in TS. The aims of our study were to describe the aortic root growth, potential aortic dilatation (AD) risk factors and cardiovascular outcomes in a cohort of patients with TS. Methods: Among 204 adult patients included, 197 were studied using a standardized 1.5 Tesla MRI protocol. AD was defined as an aortic diameter ≥20 mm/m2 at the Valsalva sinuses and/or at the ascending aorta, when indexed to body surface area. Results: At baseline, AD was present in 81/197 (41.1%) and 32/197 (16.2%) of patients, at the levels of Valsalva and ascending aorta, respectively. The aortic Valsalva diameter was larger in patients treated for thyroiditis (P < 0.001). Potential risk factors of AD were aging (P < 0.001) and the presence of bicuspid aortic valve (BAV) (P = 0.002). The hazard ratio (HR) of AD occurrence in the presence of BAV was 2.2 (95% CI: 1.33–3.71). After a median follow-up period of 5.1 years (n = 143), AD was present in 58/143 (40.6%) and 25/143 (17.5%) of patients at the levels of Valsalva and ascending aorta, respectively. The median aortic growth of the Valsalva sinuses remained stable. At the ascending aorta, it increased by 0.14 ± 0.61 mm/year. Only one aortic-related death was observed. Conclusion: AD is common in adult patients with TS. However, our results are rather reassuring, as the median aortic diameters remained stable after 5.1 years and few aortic events were observed.

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Dimensions of the Ascending Aorta in Children and Adolescents with Repaired Tetralogy of Fallot Obtained by Cardiac Magnetic Resonance Angiography

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0036-1571917 ◽

2016 ◽

Vol 64 (S 02) ◽

Author(s):

M. Grothoff ◽

M. Mende ◽

D. Gräfe ◽

I. Dähnert ◽

M. Kostelka ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Children And Adolescents ◽

Tetralogy Of Fallot ◽

Ascending Aorta ◽

Repaired Tetralogy Of Fallot

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

European Journal of Radiology Open ◽

10.1016/j.ejro.2021.100354 ◽

2021 ◽

Vol 8 ◽

pp. 100354

Author(s):

Suvipaporn Siripornpitak ◽

Apichaya Sriprachyakul ◽

Saruntorn Wongmetta ◽

Piya Samankatiwat ◽

Pirapat Mokarapong ◽

...

Keyword(s):

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Tetralogy Of Fallot ◽

Aortic Dilatation ◽

Repaired Tetralogy Of Fallot

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The “Auto-sliding Graft” Aortic Wrapping Technique

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0038-1627451 ◽

2018 ◽

Vol 67 (05) ◽

pp. 393-394 ◽

Cited By ~ 1

Author(s):

Francisco Estevez-Cid ◽

Jose María Herrera-Norena ◽

Carlos Velasco-García de Sierra

Keyword(s):

At Risk ◽

Protective Effect ◽

Simple Technique ◽

Circulatory Arrest ◽

Suture Line ◽

Ascending Aorta ◽

Aortic Dilatation ◽

Aortic Graft ◽

Patients At Risk ◽

Wrapping Technique

AbstractWe describe the “auto-sliding graft” technique, a different anastomotic option for reconstructive prosthetic procedures on the ascending aorta especially in patients at risk of circulatory arrest with mild aortic dilatation. This simple technique provides not only an important hemostatic reinforcement for the distal aortic graft anastomosis but also a protective effect on the native ascending aorta beyond the suture line.

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Arterial hypertension and unusual ascending aortic dilatation in a neonate with acute kidney injury: mechanistic computer modelling

10.31219/osf.io/anrkv ◽

2018 ◽

Author(s):

Sanjay R Kharche

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Ascending Aorta ◽

Small Vessel ◽

Aortic Dilatation ◽

Small Vessels ◽

Left Ventricle Hypertrophy ◽

Vessel Resistance ◽

Underlying Mechanisms ◽

Ventricle Hypertrophy

Background: Neonatal asphyxia caused acute kidney injury and severe hypertension in a newborn patient. An unusually dilatated ascending aorta developed within a few weeks. Dialysis and hypertensive treatment led to partial recovery of the aortic diameters. It was hypothesized that the aortic dilatation may be associated with cardiovascular changes induced by the acute kidney injury. Mathematical modelling was used to better understand the underlying mechanisms of hypertension and aortic dilatation.Methods: Patient observation included systolic blood pressure recording and echocardiographic exams. To explore underlying mechanisms of aortic dilatation and hypertension, a previous whole-body lumped parameter hemodynamics model was adapted to this study. Computer simulations were designed to permit dissection of individual mechanisms. The hypertension inducing effects of altering systemic vascular resistances, stiffnesses, and heart rate on blood flows and pressures were simulated.Results: In agreement with our clinical diagnosis, the mathematical model showed that an increase of systemic small vessel resistance is the prime cause of hypertension. Further, aortic stiffening may also cause hypertension, it was found to be secondary to the potency of systemic small vessel resistance. The cardiac output, as quantified using pressure-volume loop area, reduced significantly due to hypertension. Simultaneous left ventricle hypertrophy and small vessel blocking increased ascending aorta blood flow as well as pressure indicating an enlarged ascending aorta. In contrast, increased arterial stiffness appeared to lower the aortic blood flow and pressures.Conclusions and discussion: Systemic small vessel resistance is an important factor in arterial hypertension, and may also be a key clinical therapeutic target. Left ventricle hypertrophy may also be simultaneously ameliorated when treating systemic small vessels. Treatment of arterial stiffness appears to provide significant benefit but may be secondary to treatment of the systemic small vessels. The quantitative grading of pathophysiological mechanisms provided by the modelling may contribute to treatment recommendations. Further development and individualization of the model will augment its applicability in clinical practice.

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Oxidative Stress Inside the Pathogenesis of Ascending Aorta Aneurysms: A Clearer Vision for Identifying Promising Biomarkers and Therapeutic Targets

10.20944/preprints202111.0346.v1 ◽

2021 ◽

Author(s):

Carmela Balistreri ◽

Calogera Pisano ◽

Giovanni Ruvolo

Keyword(s):

Oxidative Stress ◽

Risk Factors ◽

Genetic Variants ◽

Complex Disease ◽

Ascending Aorta ◽

Oxygen Species ◽

Aorta Aneurysm ◽

Independent Risk Factors ◽

The Impact ◽

And Oxidative Stress

Ascending aorta aneurysm (AsAA) is a complex disease, currently defined an inflammatory disease. In the sporadic form, AsAA has, indeed, a complex physiopathology with a strong inflammatory basis, significantly modulated by genetic variants in innate/inflammatory genes, acting as independent risk factors and as largely evidenced in our recent studies performed during the last 10 years. Based on these premises, here, we want to revise the impact of reactive oxygen species (ROS) and oxidative stress on AsAA pathophysiology and consequently on the onset and progression of sporadic AsAA. This might consent to add other important pieces in the intricate puzzle of the pathophysiology of this disease with the translational aim to identify biomarkers and targets to apply in the complex management of AsAA, by facilitating the AsAA diagnosis currently based only on imaging evaluations, and the treatment exclusively founded on surgery approaches.

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Mortality Risk Factors in Tetralogy of Fallot Patients Undergoing Total Correction

Folia Medica Indonesiana ◽

10.20473/fmi.v57i2.22107 ◽

2021 ◽

Vol 57 (2) ◽

pp. 151

Author(s):

Juliana Juliana ◽

Yan Efrata Sembiring ◽

Mahrus Abdur Rahman ◽

Heroe Soebroto

Keyword(s):

Risk Factors ◽

Developing Countries ◽

Oxygen Saturation ◽

Tetralogy Of Fallot ◽

Mortality Risk ◽

Operative Risk ◽

Average Height ◽

Low Oxygen ◽

Total Correction ◽

Ventilator Time

A total correction is a preferred treatment for Tetralogy of Fallot patients in every part of the world. However, the mortality in developing countries was as high as 6.9% to 15.3%. This was a retrospective analytic study that analyzed pre and post-operative risk factors that affected mortality on TOF patients that were performed total correction in Indonesia. A total of 47 TOF patients that were performed total correction from January 2016 to September 2019 were enrolled in this study based on the inclusion criteria. Preoperative and post-operative data were obtained from medical records. In this research, the majority of mortality was found in male patients (39.3%), while the female’s rate was lower (36.8%). Overall mortality was 38.3% and one operative death was found. The average age of patients was 84.12 months (12-210 months), whereas the average height (85.56 ± 36.17cm vs. 112.93 ± 21.73) and weight (17.22kg vs. 28.21kg) were lower for mortality patients. Some significant preoperative variables were identified as mortality risk factors such as: age below 60 months (p=0.047), smaller weight and height (p=0.008; p=0.002), abnormal hematocrit (p=0.002), and oxygen saturation below 75% (p=0.018). Significant post-operative risk factors included: temperature above 38.5⁰C (p=0.000), and ventilator time of more than 48 hours (p=0.033). In conclusion, the mortality of TOF patients undergoing a total correction in developing countries was quite high. It was associated with some risk factors, such as younger age, lower weight and height, low oxygen saturation, post-operative fever, and prolonged ventilator time.

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