Abstract
Aneurysms (AN) of right ventricular outflow tract (RVOT) following tetralogy of Fallot (TOF) repair were analyzed in 53 pts. Pulmonary-to-aortic root ratio, subpulmonic chamber size and supravalvar anatomy were assessed on pre-op angiograms, and operative reports were reviewed for the extent of RVOT reconstruction. AN size, judged from angiograms obtained 2-57 mos following surgery, was graded 1-4+. Large AN (3-4+), comprising more than 1/3 of total RV area on end-systolic lateral images, were found in 20 pts (38%), 3 of whom also had marked cardiomega-ly (4+). Moderate AN (2+) were found in 14 pts (26%) and small RVOT AN (1+) in 19 pts (36%). We excluded 5 pts with a large residual VSD (Qp:Qs>1.8): 4/20 3-4+ pts and 1/33 pts with 1-2+ AN. Pre-op studies on the 3-4+ pts showed smaller pulmonary-to-aortic root diameters (.48±.05 vs .59±.06, p<.05), more tight supravalvar stenoses (38% vs 9%) and a lower incidence of appreciable subpulmonic chambers (31% vs 58%) than in other pts. Age at repair (0.8-12.8 yrs; mean 4.3±1 yr) was not different for those with large vs small AN (4.4±1.5 vs 3.3±1.2). In pts with 3-4+ AN, 15/16 (93%) required pulmonary valvotomy and RVOT patch, compared to 21/33 (63%) of the 1-2+ group. RV/LV pressure ratios were higher in the 3-4+ pts at post-op cath (.65±.12 vs .42±.05, p<.01). Multiple levels of pre-op severe stenosis leading to incomplete relief of outflow obstruction were the chief factors leading to the development of large RVOT aneurysms after TOF repair.
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Snyder, M., Levin, A. & Engle, M. RIGHT VENTRICULAR OUTFLOW TRACT ANEURYSM FOLLOWING TETRALOGY OF FALLOT REPAIR. Pediatr Res 21 (Suppl 4), 195 (1987). https://doi.org/10.1203/00006450-198704010-00172
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DOI: https://doi.org/10.1203/00006450-198704010-00172