Objective Recent histological studies of the aortic wall of tetralogy of Fallot (TOF) have revealed massive degeneration of the tunica media of the aorta. Such changes in arterial wall structure may significantly alter arterial wall mechanical properties, and may thereby cause abnormal arterial hemodynamics. The purpose of the present study was to test our hypothesis that after repair of TOF, there are abnormal arterial hemodynamics that are associated with aortic dilatation and increased afterload on the left ventricle (LV).
Methods and Results The subjects were 38 patients who had undergone complete repair of TOF, and 55 control subjects. Systemic arterial hemodynamics were investigated by measuring aortic input impedance during cardiac catheterization. The TOF patients had significantly higher characteristic impedance and pulse wave velocity and significantly lower total peripheral arterial compliance than the controls (for all 3 variables, p<0.01 vs. controls), suggesting that central and peripheral arterial wall stiffness are increased after TOF repair. In addition, the TOF patients had significantly higher arterial wave reflection than the controls. These abnormalities in arterial hemodynamics of TOF patients increased the pulsatile load on the left ventricle and significantly contributed to decreased cardiac output, even when RV function was taken into account by multivariate regression analysis. We also found that the increase in aortic wall stiffness was closely associated with the increase in aortic root diameter; this is the first report of an abnormal aortic mechanical property underlying the aortic dilatation commonly observed in TOF patients.
Conclusion These results indicating abnormal arterial hemodynamics after TOF repair highlight the importance of regular monitoring of the systemic arterial bed and potentially relevant cardiovascular events in long-term follow-up of TOF.
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