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Reduced proximal aortic compliance and elevated wall shear stress after early repair of tetralogy of Fallot.
J Thorac Cardiovasc Surg. 2018 12; 156(6):2239-2249.JT

Abstract

OBJECTIVE

Patients with tetralogy of Fallot are at risk for late aortic complications due to progressive aortic root dilation and decreased aortic compliance. Early repair normalizes aortic dimensions by preadolescence. It is not known if early repair normalizes aortic wall histology and compliance or reduces late aortic complications. We used 4-dimensional flow magnetic resonance imaging to determine if children with tetralogy of Fallot repaired in infancy had normal aortic dimensions and to characterize the aortic wall hemodynamic state and luminal flow parameters in these patients.

METHODS

Comprehensive aortic analysis with 4-dimensional flow magnetic resonance imaging was performed in 18 patients with tetralogy of Fallot who were repaired in infancy and compared with 18 normal volunteers. Peak systolic and time-averaged wall shear stress, relative area change, and distensibility were evaluated in standardized aortic planes. Qualitative grade scale flow analysis with interactive pathline visualization was used to detect pathologic flow patterns.

RESULTS

Thoracic aortic dimensions did not differ between groups, and all tetralogy of Fallot aortas were in normal range. In the tetralogy of Fallot group, ascending and descending aortic relative area change and distensibility were significantly reduced, and both peak systolic and time-averaged wall shear stress were elevated throughout the aorta. Supra-physiologic systolic helical formations occurred in the ascending aorta of 14 patients with tetralogy of Fallot (78%) versus 0 controls.

CONCLUSIONS

Despite early repair and normal aortic dimensions, preadolescents and adolescents with tetralogy of Fallot had elevated wall shear stress, increased stiffness, and pathologic systolic flow formations in the proximal aorta. Although early repair normalizes aortic dimensions in childhood, our findings suggest that patients with tetralogy of Fallot remain at risk for late aortic complications.

Authors+Show Affiliations

Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver | Anschutz Medical Campus, Aurora, Colo; Department of Bioengineering, College of Engineering and Applied Sciences, University of Colorado Denver | Anschutz Medical Campus, Aurora, Colo. Electronic address: michal.schafer@ucdenver.edu.Department of Radiology, Children's Hospital Colorado, University of Colorado Denver | Anschutz Medical Campus, Aurora, Colo.Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver | Anschutz Medical Campus, Aurora, Colo.Department of Radiology, Children's Hospital Colorado, University of Colorado Denver | Anschutz Medical Campus, Aurora, Colo.Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver | Anschutz Medical Campus, Aurora, Colo.Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver | Anschutz Medical Campus, Aurora, Colo.Section of Congenital Heart Surgery, Heart Institute, Children's Hospital Colorado, University of Colorado Denver | Anschutz Medical Campus, Aurora, Colo.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30449579

Citation

Schäfer, Michal, et al. "Reduced Proximal Aortic Compliance and Elevated Wall Shear Stress After Early Repair of Tetralogy of Fallot." The Journal of Thoracic and Cardiovascular Surgery, vol. 156, no. 6, 2018, pp. 2239-2249.
Schäfer M, Browne LP, Morgan GJ, et al. Reduced proximal aortic compliance and elevated wall shear stress after early repair of tetralogy of Fallot. J Thorac Cardiovasc Surg. 2018;156(6):2239-2249.
Schäfer, M., Browne, L. P., Morgan, G. J., Barker, A. J., Fonseca, B., Ivy, D. D., & Mitchell, M. B. (2018). Reduced proximal aortic compliance and elevated wall shear stress after early repair of tetralogy of Fallot. The Journal of Thoracic and Cardiovascular Surgery, 156(6), 2239-2249. https://doi.org/10.1016/j.jtcvs.2018.08.081
Schäfer M, et al. Reduced Proximal Aortic Compliance and Elevated Wall Shear Stress After Early Repair of Tetralogy of Fallot. J Thorac Cardiovasc Surg. 2018;156(6):2239-2249. PubMed PMID: 30449579.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reduced proximal aortic compliance and elevated wall shear stress after early repair of tetralogy of Fallot. AU - Schäfer,Michal, AU - Browne,Lorna P, AU - Morgan,Gareth J, AU - Barker,Alex J, AU - Fonseca,Brian, AU - Ivy,D Dunbar, AU - Mitchell,Max B, Y1 - 2018/09/21/ PY - 2018/06/26/received PY - 2018/08/23/revised PY - 2018/08/31/accepted PY - 2018/11/20/entrez PY - 2018/11/20/pubmed PY - 2019/10/1/medline KW - MRI KW - aorta KW - flow hemodynamics KW - tetralogy of Fallot SP - 2239 EP - 2249 JF - The Journal of thoracic and cardiovascular surgery JO - J Thorac Cardiovasc Surg VL - 156 IS - 6 N2 - OBJECTIVE: Patients with tetralogy of Fallot are at risk for late aortic complications due to progressive aortic root dilation and decreased aortic compliance. Early repair normalizes aortic dimensions by preadolescence. It is not known if early repair normalizes aortic wall histology and compliance or reduces late aortic complications. We used 4-dimensional flow magnetic resonance imaging to determine if children with tetralogy of Fallot repaired in infancy had normal aortic dimensions and to characterize the aortic wall hemodynamic state and luminal flow parameters in these patients. METHODS: Comprehensive aortic analysis with 4-dimensional flow magnetic resonance imaging was performed in 18 patients with tetralogy of Fallot who were repaired in infancy and compared with 18 normal volunteers. Peak systolic and time-averaged wall shear stress, relative area change, and distensibility were evaluated in standardized aortic planes. Qualitative grade scale flow analysis with interactive pathline visualization was used to detect pathologic flow patterns. RESULTS: Thoracic aortic dimensions did not differ between groups, and all tetralogy of Fallot aortas were in normal range. In the tetralogy of Fallot group, ascending and descending aortic relative area change and distensibility were significantly reduced, and both peak systolic and time-averaged wall shear stress were elevated throughout the aorta. Supra-physiologic systolic helical formations occurred in the ascending aorta of 14 patients with tetralogy of Fallot (78%) versus 0 controls. CONCLUSIONS: Despite early repair and normal aortic dimensions, preadolescents and adolescents with tetralogy of Fallot had elevated wall shear stress, increased stiffness, and pathologic systolic flow formations in the proximal aorta. Although early repair normalizes aortic dimensions in childhood, our findings suggest that patients with tetralogy of Fallot remain at risk for late aortic complications. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/30449579/Reduced_proximal_aortic_compliance_and_elevated_wall_shear_stress_after_early_repair_of_tetralogy_of_Fallot_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(18)32357-2 DB - PRIME DP - Unbound Medicine ER -