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Progression of aortic root dilatation and aortic valve regurgitation after the arterial switch operation.

Authors :
van der Palen RLF
van der Bom T
Dekker A
Tsonaka R
van Geloven N
Kuipers IM
Konings TC
Rammeloo LAJ
Ten Harkel ADJ
Jongbloed MRM
Koolbergen DR
Mulder BJM
Hazekamp MG
Blom NA
Source :
Heart (British Cardiac Society) [Heart] 2019 Nov; Vol. 105 (22), pp. 1732-1740. Date of Electronic Publication: 2019 Jul 10.
Publication Year :
2019

Abstract

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.<br />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.<br />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.<br />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.<br />Competing Interests: Competing interests: None declared.<br /> (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Details

Language :
English
ISSN :
1468-201X
Volume :
105
Issue :
22
Database :
MEDLINE
Journal :
Heart (British Cardiac Society)
Publication Type :
Academic Journal
Accession number :
31292191
Full Text :
https://doi.org/10.1136/heartjnl-2019-315157