Aortic Root Dilatation in Patients with Single Ventricle after Total Cavopulmonary Connection
Abstract
Extracardiac total cavopulmonary connection (EC TCPC) is the end stage of hemodynamic correction in patients with a functional single ventricle (SV). The dilatation of the aortic root and proximal portion of the ascending aorta (Ao) has a progressive nature in this cohort of patients.
The purpose of this article is to analyse the dynamics of root and proximal Ao dilatation in patients after EC TCPC in the long-term period.
Material and methods. In the period from 2005 to 2016, 137 patients with hemodynamic SV underwent EC TCPC surgery, with hospital mortality being 2.3% (n = 3). Pre- and postoperative data of the aortic root and ascending Ao dilatation have been studied in the group of 116 (84.7%) patients. Result and discussion. According to the statistical evidence, Ao dilatation has been observed mainly in older patients (older than 10 years) at the time of hemodynamic correction end stage, with longer exposure to chronic hypoxia, respectively. Transposition of the great arteries and/or pulmonary artery atresia with the left type of SV proved to be major risk factors.
Conclusions. Aortic root and ascending Ao dilatation has a progressive nature in patients with functional SV after the end stage of hemodynamic correction. The patient’s age, initial SV anatomy (anatomy of the great arteries and SV morphological type) are predictors of Ao dilatation.
References
- Pundi KN, Johnson JN, Dearani JA, Pundi KN, Li Z, Hinck CA, et al. 40-Year Follow-Up After the Fontan Operation: Long-Term Outcomes of 1,052 Patients. J Am Coll Cardiol. 2015 Oct;66(15):1700–10. https://doi.org/10.1016/j.jacc.2015.07.065
- Cozijnsen L, Braam RL, Waalewijn RA, Schepens MA, Loeys BL, van Oosterhout MF, et al. What Is New in Dilatation of the Ascending Aorta? Review of Current Literature and Practical Advice for the Cardiologist. Circulation. 2011 Mar;123(8):924–8. https://doi.org/10.1161/CIRCULATIONAHA.110.949131
- Jain D, Dietz H, Oswald G, Maleszewski JJ, Halushkaa MK. Causes and histopathology of ascending aortic disease in children and young adults. Cardiovasc Pathol. 2011 Jan-Feb;20(1):15–25. https://doi.org/10.1016/jcarpath.2009.09.008
- Kim YY, Rathod RH, Gauvreau K, Keenan EM, Del Nido P, Geva T. Factors associated with severe aortic dilation in patients with Fontan palliation. Heart. 2017 Feb;103(4):280–6. https://doi.org/10.1136/heartjnl-2016-309615
- Kojima T, Kuwata S, Kurishima C, Iwamoto Y, Saiki H, Ishido H, et al. Aortic root dilatation and aortic stiffness in patients with single ventricular circulation. Circ J. 2014;78:2507–11.
- Erez E, Tam VK, Galliani C, Lashus A, Doublin NA, Peretti J. Valve-sparing aortic root replacement for patients with a Fontan circulation. J Heart Valve Dis. 2012 Mar;21(2):175–80.
- Francois K. Aortopathy associated with congenital heart disease: A current literature review. Ann Pediatr Cardiol. 2015 Jan-Apr;8(1):25–36. https://doi.org/10.4103/0974-2069.149515
- Egan M, Phillips A, Cook S. Aortic Dissection in the Adult Fontan with Aortic Root Enlargement. Pediatr Cardiol. 2009 May;30(4):562–3. https://doi.org/10.1007/s00246-009-9435-0
