Background We examined the features, determinants and rate of progression related to aortic dilatation in adults with repaired tetralogy of Fallot (rTOF).

Methods and Results One-hundred-and-ten adults with rTOF and native aorta, baseline median age 30.9 (IQR22.9–39.4) years were assessed by serial cardiovascular magnetic resonance (CMR), and over a median follow-up of 6.3 (IQR5.1–7.6) years. Aortic dimensions were measured at sinus, sinotubular junction (STJ) and mid-ascending aortic level. Dilatation was defined as diameter >2 standard deviations larger than normal for the age.

Seventy-six patients (69%) had aortic dilatation, of which 27% at sinus, 66% at STJ, and 21% had ascending aortic level (figure 1). Baseline predictors of aortic dilatation were male gender and previous history of palliation. Forty-seven percent had increase in aortic diameters, 25% at sinus, 21% at STJ and 35% at ascending aortic level, at a rate of 0.05 ± 0.1, 0.06 ± 0.14 and 0.12 ± 0.26 mm/year respectively. Predictors of aortic diameter increase at STJ level were older age, later repair and right aortic arch. No predictors of aortic diameter increase at other levels were ascertained.

Conclusions Aortic dilatation was observed in two thirds of our adult with rTOF patients, affecting not only the aortic root but the ascending aorta as well. However, the rates of progression were very low. These data do not support frequent aortic assessment in follow-up and aggressive prophylactic aortic root replacement.

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Abstract P5 Figure 1

Measured aortic diameter at each level plotted against the age. The grey zone represents 2 standard deviation intervals from normal value in relation to the age.