Analysis of the aortic root in patients with tetralogy of Fallot undergoing early repair: Form follows function
Objective Aortic root dilatation remains of concern late after repair for tetralogy of Fallot (ToF). We have previously demonstrated that the aortic root size decreases progressively after early correction. To test whether the aortic wall changes are intrinsic or acquired, a histologic study was per...
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| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2014-10, Vol.148 (4), p.1555-1559 |
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| creator | François, Katrien, MD, PhD Creytens, David, MD De Groote, Katya, MD Panzer, Joseph, MD Vandekerckhove, Kristof, MD De Wolf, Daniel, MD, PhD Bové, Thierry, MD |
| description | Objective Aortic root dilatation remains of concern late after repair for tetralogy of Fallot (ToF). We have previously demonstrated that the aortic root size decreases progressively after early correction. To test whether the aortic wall changes are intrinsic or acquired, a histologic study was performed of infants at early repair. Methods From 24 of 31 infants undergoing ToF repair (mean age, 5.9 ± 4.9 months), ascending aortic biopsies were obtained. After conventional staining, the specimens were given a histologic score (0-3) for medionecrosis, ground substance accumulation, fibrosis, smooth muscle cell disarray, and apoptosis. The aortic root diameters were monitored using echocardiography for ≤2 years postoperatively. Results Nearly one half of the specimens showed signs of fibrosis (45%), with increased mucoid accumulation in 15% and elastin fragmentation in 5%. The aortic root was dilated in all infants at operation (mean indexed diameter—annulus, 38.1 ± 5.8; sinus, 47.8 ± 6; sinotubular junction, 38.7 ± 5.4 mm/m2 ) and had regressed significantly within 2 years (mean indexed diameter—annulus, 27.9 ± 4.7; sinus, 36.4 ± 5.1; sinotubular junction, 30.4 ± 6 mm/m2 ; P |
| doi_str_mv | 10.1016/j.jtcvs.2013.11.044 |
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We have previously demonstrated that the aortic root size decreases progressively after early correction. To test whether the aortic wall changes are intrinsic or acquired, a histologic study was performed of infants at early repair. Methods From 24 of 31 infants undergoing ToF repair (mean age, 5.9 ± 4.9 months), ascending aortic biopsies were obtained. After conventional staining, the specimens were given a histologic score (0-3) for medionecrosis, ground substance accumulation, fibrosis, smooth muscle cell disarray, and apoptosis. The aortic root diameters were monitored using echocardiography for ≤2 years postoperatively. Results Nearly one half of the specimens showed signs of fibrosis (45%), with increased mucoid accumulation in 15% and elastin fragmentation in 5%. The aortic root was dilated in all infants at operation (mean indexed diameter—annulus, 38.1 ± 5.8; sinus, 47.8 ± 6; sinotubular junction, 38.7 ± 5.4 mm/m2 ) and had regressed significantly within 2 years (mean indexed diameter—annulus, 27.9 ± 4.7; sinus, 36.4 ± 5.1; sinotubular junction, 30.4 ± 6 mm/m2 ; P < .0001). The total histology score showed no correlation with indexed diameter regression at 2 years. Conclusions Infants with ToF undergoing repair around 6 months old already had limited features of aortic wall degradation at surgery. Echocardiographic follow-up, however, demonstrated significant reductions in the indexed aortic diameters. We presume that early repair of ToF will prevent a disproportionate aortic diameter increase by halting progression of the limited histologic changes potentially predisposing to late aortic dilatation.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2013.11.044</identifier><identifier>PMID: 24503321</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aorta, Thoracic ; Aortic Diseases - diagnostic imaging ; Aortic Diseases - pathology ; Biopsy ; Blalock-Taussig Procedure ; Cardiothoracic Surgery ; Dilatation, Pathologic ; Disease Progression ; Echocardiography ; Female ; Humans ; Infant ; Male ; Prospective Studies ; Risk Factors ; Tetralogy of Fallot - surgery ; Treatment Outcome</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2014-10, Vol.148 (4), p.1555-1559</ispartof><rights>The American Association for Thoracic Surgery</rights><rights>2014 The American Association for Thoracic Surgery</rights><rights>Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c529t-18426988122f4bff26c31f10fece87a011427fc465056d7086f126bfeda90f193</citedby><cites>FETCH-LOGICAL-c529t-18426988122f4bff26c31f10fece87a011427fc465056d7086f126bfeda90f193</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jtcvs.2013.11.044$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24503321$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>François, Katrien, MD, PhD</creatorcontrib><creatorcontrib>Creytens, David, MD</creatorcontrib><creatorcontrib>De Groote, Katya, MD</creatorcontrib><creatorcontrib>Panzer, Joseph, MD</creatorcontrib><creatorcontrib>Vandekerckhove, Kristof, MD</creatorcontrib><creatorcontrib>De Wolf, Daniel, MD, PhD</creatorcontrib><creatorcontrib>Bové, Thierry, MD</creatorcontrib><title>Analysis of the aortic root in patients with tetralogy of Fallot undergoing early repair: Form follows function</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Objective Aortic root dilatation remains of concern late after repair for tetralogy of Fallot (ToF). We have previously demonstrated that the aortic root size decreases progressively after early correction. To test whether the aortic wall changes are intrinsic or acquired, a histologic study was performed of infants at early repair. Methods From 24 of 31 infants undergoing ToF repair (mean age, 5.9 ± 4.9 months), ascending aortic biopsies were obtained. After conventional staining, the specimens were given a histologic score (0-3) for medionecrosis, ground substance accumulation, fibrosis, smooth muscle cell disarray, and apoptosis. The aortic root diameters were monitored using echocardiography for ≤2 years postoperatively. Results Nearly one half of the specimens showed signs of fibrosis (45%), with increased mucoid accumulation in 15% and elastin fragmentation in 5%. The aortic root was dilated in all infants at operation (mean indexed diameter—annulus, 38.1 ± 5.8; sinus, 47.8 ± 6; sinotubular junction, 38.7 ± 5.4 mm/m2 ) and had regressed significantly within 2 years (mean indexed diameter—annulus, 27.9 ± 4.7; sinus, 36.4 ± 5.1; sinotubular junction, 30.4 ± 6 mm/m2 ; P < .0001). The total histology score showed no correlation with indexed diameter regression at 2 years. Conclusions Infants with ToF undergoing repair around 6 months old already had limited features of aortic wall degradation at surgery. Echocardiographic follow-up, however, demonstrated significant reductions in the indexed aortic diameters. We presume that early repair of ToF will prevent a disproportionate aortic diameter increase by halting progression of the limited histologic changes potentially predisposing to late aortic dilatation.</description><subject>Aorta, Thoracic</subject><subject>Aortic Diseases - diagnostic imaging</subject><subject>Aortic Diseases - pathology</subject><subject>Biopsy</subject><subject>Blalock-Taussig Procedure</subject><subject>Cardiothoracic Surgery</subject><subject>Dilatation, Pathologic</subject><subject>Disease Progression</subject><subject>Echocardiography</subject><subject>Female</subject><subject>Humans</subject><subject>Infant</subject><subject>Male</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Tetralogy of Fallot - surgery</subject><subject>Treatment Outcome</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkcFu1DAQhi0EokvhCZCQj1wSZpzESZBAqqpui1SJAyBxs7zOeOuQjRfbaZW3J2ELBy6c5vL9M5rvZ-w1Qo6A8l2f98ncx1wAFjliDmX5hG0Q2jqTTfX9KdsACJFVQhRn7EWMPQDUgO1zdibKCopC4Ib5i1EPc3SRe8vTHXHtQ3KGB-8TdyM_6uRoTJE_uHTHE6WgB7-fV3qrh2GBprGjsPdu3HPSYZh5oKN24T3f-nDg1i_QQ-R2Gk1yfnzJnlk9RHr1OM_Zt-3V18ub7Pbz9afLi9vMVKJNGTalkG3ToBC23FkrpCnQIlgy1NQaEEtRW1PKCirZ1dBIi0LuLHW6BYttcc7envYeg_85UUzq4KKhYdAj-SkqrKREhKZd0eKEmuBjDGTVMbiDDrNCUKtp1avfptVqWiGqxfSSevN4YNodqPub-aN2AT6cAFrevHcUVDSLSkOdC2SS6rz7z4GP_-TN4EZn9PCDZoq9n8JS3fKJikKB-rKWvXaNBWDZgix-Aehgphs</recordid><startdate>20141001</startdate><enddate>20141001</enddate><creator>François, Katrien, MD, PhD</creator><creator>Creytens, David, MD</creator><creator>De Groote, Katya, MD</creator><creator>Panzer, Joseph, MD</creator><creator>Vandekerckhove, Kristof, MD</creator><creator>De Wolf, Daniel, MD, PhD</creator><creator>Bové, Thierry, MD</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20141001</creationdate><title>Analysis of the aortic root in patients with tetralogy of Fallot undergoing early repair: Form follows function</title><author>François, Katrien, MD, PhD ; Creytens, David, MD ; De Groote, Katya, MD ; Panzer, Joseph, MD ; Vandekerckhove, Kristof, MD ; De Wolf, Daniel, MD, PhD ; Bové, Thierry, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c529t-18426988122f4bff26c31f10fece87a011427fc465056d7086f126bfeda90f193</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aorta, Thoracic</topic><topic>Aortic Diseases - diagnostic imaging</topic><topic>Aortic Diseases - pathology</topic><topic>Biopsy</topic><topic>Blalock-Taussig Procedure</topic><topic>Cardiothoracic Surgery</topic><topic>Dilatation, Pathologic</topic><topic>Disease Progression</topic><topic>Echocardiography</topic><topic>Female</topic><topic>Humans</topic><topic>Infant</topic><topic>Male</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Tetralogy of Fallot - surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>François, Katrien, MD, PhD</creatorcontrib><creatorcontrib>Creytens, David, MD</creatorcontrib><creatorcontrib>De Groote, Katya, MD</creatorcontrib><creatorcontrib>Panzer, Joseph, MD</creatorcontrib><creatorcontrib>Vandekerckhove, Kristof, MD</creatorcontrib><creatorcontrib>De Wolf, Daniel, MD, PhD</creatorcontrib><creatorcontrib>Bové, Thierry, MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>François, Katrien, MD, PhD</au><au>Creytens, David, MD</au><au>De Groote, Katya, MD</au><au>Panzer, Joseph, MD</au><au>Vandekerckhove, Kristof, MD</au><au>De Wolf, Daniel, MD, PhD</au><au>Bové, Thierry, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Analysis of the aortic root in patients with tetralogy of Fallot undergoing early repair: Form follows function</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2014-10-01</date><risdate>2014</risdate><volume>148</volume><issue>4</issue><spage>1555</spage><epage>1559</epage><pages>1555-1559</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><abstract>Objective Aortic root dilatation remains of concern late after repair for tetralogy of Fallot (ToF). We have previously demonstrated that the aortic root size decreases progressively after early correction. To test whether the aortic wall changes are intrinsic or acquired, a histologic study was performed of infants at early repair. Methods From 24 of 31 infants undergoing ToF repair (mean age, 5.9 ± 4.9 months), ascending aortic biopsies were obtained. After conventional staining, the specimens were given a histologic score (0-3) for medionecrosis, ground substance accumulation, fibrosis, smooth muscle cell disarray, and apoptosis. The aortic root diameters were monitored using echocardiography for ≤2 years postoperatively. Results Nearly one half of the specimens showed signs of fibrosis (45%), with increased mucoid accumulation in 15% and elastin fragmentation in 5%. The aortic root was dilated in all infants at operation (mean indexed diameter—annulus, 38.1 ± 5.8; sinus, 47.8 ± 6; sinotubular junction, 38.7 ± 5.4 mm/m2 ) and had regressed significantly within 2 years (mean indexed diameter—annulus, 27.9 ± 4.7; sinus, 36.4 ± 5.1; sinotubular junction, 30.4 ± 6 mm/m2 ; P < .0001). The total histology score showed no correlation with indexed diameter regression at 2 years. Conclusions Infants with ToF undergoing repair around 6 months old already had limited features of aortic wall degradation at surgery. Echocardiographic follow-up, however, demonstrated significant reductions in the indexed aortic diameters. We presume that early repair of ToF will prevent a disproportionate aortic diameter increase by halting progression of the limited histologic changes potentially predisposing to late aortic dilatation.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24503321</pmid><doi>10.1016/j.jtcvs.2013.11.044</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aorta, Thoracic Aortic Diseases - diagnostic imaging Aortic Diseases - pathology Biopsy Blalock-Taussig Procedure Cardiothoracic Surgery Dilatation, Pathologic Disease Progression Echocardiography Female Humans Infant Male Prospective Studies Risk Factors Tetralogy of Fallot - surgery Treatment Outcome |
| title | Analysis of the aortic root in patients with tetralogy of Fallot undergoing early repair: Form follows function |
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