Aortic Root Dilatation Measured by Cardiac Magnetic Resonance in Patients with Repaired Tetralogy of Fallot.

BACKGROUND: Aortic root dilatation (AoD) frequently occurs following repaired tetralogy of Fallot (rTOF). The objective of this study was to assess aortic dimensions, investigate the prevalence of AoD, and identify predictors of AoD in rTOF patients. METHODS: A cross-sectional retrospective study was conducted in repaired TOF patients from 2009 to 2020. Aortic root diameters were measured by cardiac magnetic resonance (CMR). Severe AoD of the aortic sinus (AoS) was defined as a Z-score (z) of >4, reflecting a mean percentile ≥99.99%. RESULTS: Two hundred forty-eight patients, with a median age of 28.2 years (10.2-65.3 years), were included in the study. The median age at the time of repair was 6.6 years (0.8-40.5 years) and the median interval between the repair and CMR study was 18.9 years (2.0-54.8 years). The prevalence of severe AoD was found to be 35.2% when defined by an AoS z greater than 4 and 27.6% when defined by a AoS diameter ≥40 mm, respectively. A total of 101 patients (40.7%) had aortic regurgitation (AR), with 7 patients (2.8%) having moderate AR. Multivariate analysis revealed that severe AoD was only associated with the left ventricular end diastolic volume index (LVEDVi) and a longer duration after repair. The age at the time of repair for TOF was found not to be correlated with the development of AoD. CONCLUSIONS: After repair of TOF, severe AoD was found to be prevalent, but no fatal complications were observed in our study. Mild AR was also commonly observed. Larger LVEDVi and a longer duration after repair were identified as factors associated with the development of severe AoD. Therefore, routine monitoring of AoD is recommended.

P-wave dispersion as a simple tool for screening childhood obstructive sleep apnea syndrome.

INTRODUCTION: The gold standard for the diagnosis of childhood obstructive sleep apnea syndrome (OSAS) diagnosis is polysomnography; however, electrocardiography (ECG) may provide a simpler alternative. P-wave dispersion (PWD), the difference between the maximum and minimum P-wave duration measured by 12-lead ECG, is increased in adult OSAS but has not been researched in childhood OSAS. The aims of this study were to determine the PWD and cut-off value for the diagnosis of childhood OSAS and its association with severity. METHODS: A total of 77 children with confirmed OSAS and 44 control participants underwent surface 12-lead ECG. P-wave duration was measured using a digital caliper by a researcher blinded to the groups. RESULTS: Median (interquartile range) PWD in children with OSAS (median age = 82.8 months, range = 24-194 months) was significantly higher than that in the control group (median age = 73.4 months, range = 12-156 months): 38.3 (29.7-50.5) vs 25.5 (20.5-30.5) milliseconds, respectively (p < 0.0001). Subgroup analysis according to OSAS severity categorized by the apnea-hypopnea index from polysomnography demonstrated that PWD in the severe OSAS group (n = 24) was significantly higher than that in the mild-to-moderate OSAS group (n = 53): 48.5 (34.7-67.4) vs 35.5 (28.2-47.8) milliseconds, respectively (p = 0.006). A cut-off value of PWD at 26.5 ms from the receiver operating characteristic curve for the diagnosis showed the area under the curve to be 0.839, with a sensitivity of 89.6% and a specificity of 61.4%. CONCLUSION: PWD was significantly increased in children with OSAS, particularly in severe cases. PWD could be a useful tool for screening childhood OSAS.