PT  - JOURNAL ARTICLE
AU  - van der Palen, Roel L F
AU  - van der Bom, Teun
AU  - Dekker, Annika
AU  - Tsonaka, Roula
AU  - van Geloven, Nan
AU  - Kuipers, Irene M
AU  - Konings, Thelma C
AU  - Rammeloo, Lukas A J
AU  - Ten Harkel, Arend D J
AU  - Jongbloed, Monique R M
AU  - Koolbergen, Dave R
AU  - Mulder, Barbara J M
AU  - Hazekamp, Mark G
AU  - Blom, Nico A
TI  - Progression of aortic root dilatation and aortic valve regurgitation after the arterial switch operation
AID  - 10.1136/heartjnl-2019-315157
DP  - 2019 Nov 01
TA  - Heart
PG  - 1732--1740
VI  - 105
IP  - 22
4099  - http://heart.bmj.com/content/105/22/1732.short
4100  - http://heart.bmj.com/content/105/22/1732.full
SO  - Heart2019 Nov 01; 105
AB  - Objective To study neo-aortic growth and the evolution of neo-aortic valve regurgitation (AR) in patients with transposition of the great arteries (TGA) after arterial switch operation (ASO) from newborn to adulthood and to identify patients at risk.Methods Neo-aortic dimensions (annulus/root/sinotubular junction) and neo-aortic valve regurgitation were assessed serially in 345 patients with TGA who underwent ASO between 1977 and 2015. Linear mixed-effect models were used to assess increase of neo-aortic dimensions over time and to identify risk factors for dilatation. Risk factor analysis for AR by using time-dependent Cox regression models.Results After a rapid increase in the first year after ASO and proportional growth in childhood, neo-aortic dimensions continue to increase in adulthood without stabilisation. Annual diameter increase in adulthood was 0.39±0.06, 0.63±0.09 and 0.54±0.11 mm for, respectively, neo-aortic annulus, root and sinotubular junction, all significantly exceeding normal growth. AR continues to develop over time: freedom from AR ≥moderate during the first 25 years post-ASO was 69%. Risk factors for root dilatation were complex TGA anatomy (TGA-ventricular septal defect (VSD), double outlet right ventricle with subpulmonary VSD) and male gender. Risk factors for AR ≥moderate were: complex TGA anatomy and neo-aortic growth. Per millimetre increase in aortic root dimension, there was a 9% increase in the hazard of AR ≥moderate. Bicuspid pulmonary valve did not relate to the presence of root dilatation or AR.Conclusion After ASO, neo-aortic dilatation proceeds beyond childhood and is associated with an increase in AR incidence over time. Careful follow-up of the neo-aortic valve and root function is mandatory, especially in males and in patients with complex TGA anatomy.