ArticleThe international journal of cardiovascular imaging2025
Clockwise aortic root rotation in patients with tetralogy of fallot assessed with cardiovascular magnetic resonance imaging.
Article in The international journal of cardiovascular imaging, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Rotation of the aortic root (AoR) has previously been observed in children with Tetralogy of Fallot (TOF) using 2-dimensional echocardiography. The present study uses cardiovascular magnetic resonance (CMR) imaging to assess whether a clockwise AoR rotation is a common feature in adults with TOF. AoR rotation was measured in the CMR images of consecutive adult patients with corrected TOF and controls. The AoR rotation was assessed in the parasternal short-axis view by measuring the angle of the non-coronary sinus (angle NCS) relative to the interatrial septum (IAS). The angle between IAS and posterior atrial wall was measured to asses IAS reliability as a key anatomical landmark. Inter-observer agreement was determined using intra-class correlation coefficients (ICC). A total of 25 adults with TOF (mean age:33.2 ± 13.1 years;52% male) and 30 controls (mean age:54.5 ± 19.0 years;50% male) were assessed. The angle NCS was greater in TOF patients than in controls (46.2 ± 17.1⁰vs.23.4 ± 15.0⁰, p < 0.001), reflecting a clockwise AoR rotation. As expected, between TOF patients and controls there was no significant difference in the angle IAS (81.1 ± 8.4⁰vs.78.4 ± 9.5⁰, p = 0.46). Inter-observer reliability of CMR measurements was good for the clinically important angle NCS (ICC 0.77, 95%-CI:0.63-0.86) and moderate for the angle IAS (ICC 0.68, 95%-CI:0.51-0.80). This is the first study to demonstrate with CMR that a clockwise rotation of the AoR is a common feature in patients with TOF. This clinical investigation shows the value of CMR for the assessment of the spatial AoR position in adult patients with congenital heart disease.
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