Thoracic aortic dissection and rupture in conotruncal cardiac defects: A population-based study

- An administrative database search including 37.9 million hospitalizations found 12,016 TAD.
- TAD and CHD coexisted in 214 patients yielding an incidence of 5.6 per million hospitalizations.
- Conotruncal disease was found in 3% of CHD-associated TAD (3 TOF, 2 D-TGA, 1 truncus arteriosus).
- On statistical analysis, conotruncal CHD was not independently associated with TAD.

BackgroundAlthough the risk of thoracic aortic dissection and rupture (TAD) is well-known in bicuspid aortic valve (BAV), the risk of TAD in other congenital heart diseases (CHD), particularly conotruncal lesions like tetralogy of Fallot (TOF), truncus arteriosus, D-transposition of the great arteries (D-TGA), and double outlet right ventricle is currently unknown. The primary purpose of this study was to describe TAD in conotruncal CHD, and the secondary purpose was to explore whether an association exists between TAD and conotruncal CHD.Methods and resultsUsing the Texas Inpatient Public Use Data File, an administrative database of all Texas hospitalizations, including > 37.9 million hospitalizations from January 1999 through June 2012, 12,016 cases of TAD and 214 cases of TAD in CHD were identified. The most common lesions were BAV (42%), atrial septal defect (21%), aortic coarctation (7%), ventricular septal defect (6%), and patent ductus arteriosus (4%). Three patients with TOF, 2 with D-TGA, and 1 with truncus arteriosus were admitted with TAD. An exploratory case-control study in patients older than 1 year using multilevel logistic regression models to evaluate the association between CHD and TAD that controlled for known TAD risk factors demonstrated a significant association between TAD and BAV (OR 10, 95% CI 8.2-13) but not coarctation of the aorta or any conotruncal lesion.ConclusionsTAD in conotruncal CHD is exquisitely rare. In our hospitalized population, there was no increased occurrence of TAD in conotruncal CHD above what would be expected in the rest of the hospitalized population.