Learning objectives
·1. To familiarize the reader with common post repair complications encountered at follow-up imaging.
·2. To discuss various decision making criteria and their assessment on cardiac MRI.
Background
INTRODUCTION
Tetrology of Fallot (TOF) is the most frequent cyanotic congenital heart disease(CHD) with an average incidence of approximately 0.5/1000 live births(1). Although TOF was considered as highly lethal malformation, with advances in diagnosis and surgical techniques, the early mortality for surgically repaired TOF(rTOPF) is low with an early mortality rate of approximately 2%. However, despite these advances there is high incidence of morbidity and mortality in adulthood due to residual anatomic defects, hemodynamic abnormalities and complications(2,3). The rTOF patients have a variable degree of...
Findings and procedure details
ANATOMIC FEATURES OF TOF
The embryological abnormality in TOF is underdevelopment of the subpulmonary infundibulum(Van Praagh theory) or the anterocephalad deviation of the outlet septum( Anderson theory). This anterior misalignment of the conal septum leads to the following anatomic findings: subaortic ventricular septal defect (VSD), an overriding aortic root, pulmonary outflow obstruction, and subsequent RV hypertrophy . The level of pulmonary outflow obstruction can be at right ventrciular outflow tract(RVOT), pulmonary valve, main pulmonary artery (PA) and/or branch pulmonary arteries(6).
SURGICAL STRATAGIES IN MANAGEMENT OF...
Conclusion
As there is increase in the number of grown-ups living with repaired CHD, treatment and follow-up of this growing group of patients require the expertise of a multidisciplinary team(4,5). The cardiac imager plays an important role, interpreting many different imaging modalities, thus requiring full understanding of TOF anatomical features, surgical approaches, post operative complications and their implications in clincial decision making.
Personal information and conflict of interest
J. Gaduputi; 560054, KA/IN - nothing to disclose A. Goel; Saharanpur, NEW DELHI/IN - nothing to disclose B. Nagabhushana Reddy; Bangalore/IN - nothing to disclose P. Reddy; Bangalore/IN - nothing to disclose S. Viswamitra; Bangalore/IN - nothing to disclose
References
1.G.Nollert,T.Fischlein,S.Bouterwerk,C.Böhmer,W.Klinner,B.ReichartLong-term survival in patients with repair of tetralogy of Fallot: 36-year follow-up of 490 survivors of the first year after surgical repair. J Am Coll Cardiol,30(1997), pp.1374-1383
2. M.A.Gatzoulis,S.Balaji,S.A.Webber,et al.Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study Lancet,356(2000), pp.975-981
3. E.A.Bacha,A.M.Scheule,D.Zurakowski,et al.Long-term results after early primary repair of tetralogy of Fallot. J Thorac Cardiovasc Surg,122(2001), pp.154-161
4. P.Ou,L.Iserin,O.Raisky,et al.Postoperative cardiac lesions after cardiac surgery in childhood Pediatr Radiol,40(2010), pp.885-894
5. Marelli AJ, Mackie AS, Ionescu-Ittu...