Compression of the pulmonary artery in patients with repaired tetralogy of Fallot.

Zweers, T. (Tjerk) (2016) Compression of the pulmonary artery in patients with repaired tetralogy of Fallot. thesis, Medicine.

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Abstract

Tetralogy of Fallot (TOF) is the most common congenital heart disease that needs surgical intervention. This syndrome is associated with multiple late and chronic complications, and patients require a life-time follow-up. Main complications are pulmonary regurgitation, obstruction of the right ventricular outflow tract and stenosis of the right pulmonary artery, which all need surgical intervention. The mechanism of regurgitation is well understood and described, but the mechanisms of obstruction of the right ventricular outflow tract and stenosis of the right pulmonary artery are not clear. Compression of the right pulmonary artery by the aorta may cause this severe complication. The aim of this study is to assess the exact location and the diameter of the thoracic aorta in relation to the pulmonary branch arteries and the main bronchi. This may gain insight in pathophysiology of stenosis of the right pulmonary artery and potential new strategies for intervention. We evaluated cardiac MR images of Fallot patients and compared these with MR images of a control group. A total of 192 patients were included, 149 with TOF and 43 controls. Diameters of the ascending and descending aorta, the pulmonary arteries and main bronchi were measured and indexed for body surface area. Comparisons between the TOF group and the control group were made using student’s T-tests for independent variables. Correlations were evaluated using regression analysis and Pearson’s correlation tests. Diameters of the proximal right pulmonary artery of TOF were significant smaller compared to the control group. The pulmonary artery seemed to be compressed by the ascending aorta, yet there was no direct compression against the spine or descending aorta. The ascending aorta is significant larger in TOF patients, yet the inter-aortic space was not smaller in patients with TOF compared with controls. TOF patients with a right aortic arch have a decreased inter-aortic space, but this did not influence the diameters of the right pulmonary arteries. Left-right diameters of the main bronchi were significant larger in TOF patients. In conclusion, the present study demonstrated that the right pulmonary branch artery in TOF patients is compressed. Several factors may be responsible for the compression of the right pulmonary artery, and the ascending aorta seemed to play an important role. More research is needed to prove the hypothesis that stenosis of the right pulmonary artery is due to compression of the ascending aorta.

Item Type:	Thesis (Thesis)
Supervisor name:	Ebels, Prof. dr. T. / and Willems, dr. T.P. and University Medical Centre Groningen, Guide Congenital Heart
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:44
Last Modified:	25 Jun 2020 10:44
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/565

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