Imaging in repaired tetralogy of Fallot with a focus on recent advances in echocardiography

Imaging is essential for the management of adults with repaired tetralogy of Fallot (rToF). Echocardiography and cardiac magnetic resonance imaging are the central modalities to assess rToF. Here we review recent literature on imaging rToF, focusing on echocardiography and advances in assessment of cardiac mechanics.

Several two-dimensional, three-dimensional, and Doppler echo parameters have been proposed to assess pulmonary regurgitation, right ventricular volumes and ejection fraction, but most of them still have important limitations in their feasibility and reliability compared to cardiac magnetic resonance (CMR). Myocardial deformation imaging to study ventricular and atrial mechanics, regional function, ventricular-ventricular interactions, and electro-mechanical dyssynchrony has yielded insights into the pathophysiologic mechanisms of right ventricular and left ventricular dysfunction; thereby predicting clinical outcomes and exercise capacity, allowing among others, evaluation of the impact of pulmonary valve replacement (PVR). Emerging technologies are expected to further our understanding of the drivers of dysfunction and guide indications and timing of PVR.

Echocardiography and CMR have complementary and overlapping roles in rToF and contribute to our understanding of its pathophysiology and management.