• Y F Cheung, X Ou, and S J Wong.
• Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Grantham Hospital, The University of Hong Kong, Hong Kong, China. xfcheung@hkucc.hku.hk
• Heart. 2006 Dec 1; 92 (12): 1827-30.

ObjectivesTo test the hypotheses that (1) the central conduit arteries stiffen preferentially over the peripheral conduit arteries in patients with repaired tetralogy of Fallot (ToF); and (2) central arterial stiffening is related to aortic root dilatation.Design And PatientsHeart-femoral pulse wave velocity (PWV), femoral-ankle PWV, carotid augmentation index and body surface area-adjusted aortic sinotubular dimension were determined in 31 children after ToF repair and compared with those in 31 age-matched controls after left-to-right shunt repair. In addition, the PWVs and augmentation index were related to the sinotubular junction dimension.SettingsTertiary paediatric cardiac centre.ResultsCompared with controls, patients had significantly greater heart-femoral PWV (mean 666 (SD 151) v 587 (81) cm/s, p = 0.021) and carotid augmentation index (-14.1 (17.0)% v -25.2 (14.6)%, p = 0.016), whereas the right (888 (202) v 845 (207) cm/s, p = 0.42) and left (918 (227) v 851 (215) cm/s, p = 0.25) femoral-ankle PWVs were similar between the two groups. The sinotubular junction z score of patients was significantly greater than that of controls (4.7 (1.5) v 1.1 (1.4), p < 0.001). Univariate analysis showed that the sinotubular junction z score correlated positively with heart-femoral PWV (r = 0.43, p = 0.001) and carotid augmentation index (r = 0.46, p = 0.001). Multiple linear regression similarly identified heart-femoral PWV (beta = 0.30, p = 0.04) and carotid augmentation index (beta = 0.31, p = 0.04) (model R(2) = 0.26) as significant determinants of sinotubular junction z score.ConclusionsThe aorta stiffens in patients with repaired ToF, which may contribute to progressive dilatation of the aortic root in the long term.

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