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Review
. 2020 Aug;8(15):966.
doi: 10.21037/atm.2020.02.18.

Tetralogy of Fallot: cardiac imaging evaluation

Carlos Jerjes Sánchez Ramírez  1 , Leopoldo Pérez de Isla  1
Affiliations
Review

Tetralogy of Fallot: cardiac imaging evaluation

Carlos Jerjes Sánchez Ramírez et al. Ann Transl Med. 2020 Aug.

Abstract

Thanks to advances in pediatric cardiology, most infants with tetralogy of Fallot (TOF) now survive into adulthood. This relatively new population of adult patients may face long-term complications, including pulmonary regurgitation (PR), right ventricular (RV) tract obstruction, residual shunts, RV dysfunction, and arrythmias. They will often need to undergo pulmonary valve (PV) replacement and other invasive re-interventions. However, the optimal timing for these procedures is challenging, largely due to the complexity of evaluating RV volume and function. The options for the follow-up of these patients have rapidly evolved from an angiography-based approach to the surge of advanced imaging techniques, mainly echocardiography, cardiac magnetic resonance (CMR), and computer tomography (CT). In this review, we outline the indications, strengths and limitations of these modalities in the adult TOF population.

Keywords: Computed tomography; cardiac magnetic resonance (CMR); echocardiography; tetralogy of Fallot (TOF).

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Conflict of interest statement

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm.2020.02.18). The series “Structural Heart Disease: The Revolution” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Chest X-ray of a 26-year-old patient with history of complete TOF repair in infancy. Note the severe cardiomegaly and RVOT dilatation. TOF, tetralogy of Fallot; RVOT, right ventricular outflow tract.
Figure 2
Figure 2
Different degrees of PR after TOF complete repair. Left: Mild PR. Center: Moderate PR. Right: Severe PR. Note the wide jet and steep deceleration of the continuous wave doppler curve compared to the mild PR curve. TOF, tetralogy of Fallot; PR, pulmonary regurgitation.
Figure 3
Figure 3
Cine CMR 4 chamber view of a patient with repaired TOF and positive clinical evolution. The RV is mildly dilated and with mild RV hypertrophy. CMR, cardiac magnetic resonance; TOF, tetralogy of Fallot; RV, right ventricular.
Figure 4
Figure 4
CMR cine images depicting a patient with PS in systole (left) and diastole (center). The doppler curve (right), with a maximum velocity close to 5 m/s, resembles an aortic stenosis curve, and corresponds to severe PS. CMR, cardiac magnetic resonance; PS, pulmonary stenosis.
Figure 5
Figure 5
Regurgitant fraction calculation in a patient with repaired TOF and severe PR. The first image displays the imaging plane, perpendicular to the proximal main pulmonary artery. The second image shows volume and direction of flow over time. TOF, tetralogy of Fallot; PR, pulmonary regurgitation.
Figure 6
Figure 6
Imaging planes for calculation of pulmonary-to-systemic blood flow calculation (Qp:Qs)
Figure 7
Figure 7
CT reconstruction of a patient with an absent right coronary artery.
See this image and copyright information in PMC

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