Tetralogy of Fallot: cardiac imaging evaluation

Area of Science:

• Cardiology
• Pediatric Cardiology
• Adult Congenital Heart Disease

Background:

• Advances in pediatric cardiology have increased the survival of Tetralogy of Fallot (TOF) patients into adulthood.
• Adult TOF survivors face potential long-term complications such as pulmonary regurgitation, right ventricular dysfunction, and arrhythmias.
• Pulmonary valve replacement and re-interventions are common but require precise timing.

Purpose of the Study:

• To review the indications, strengths, and limitations of advanced imaging modalities for adult Tetralogy of Fallot patients.
• To address the challenges in evaluating right ventricular (RV) volume and function for optimal intervention timing.
• To provide a guide for the follow-up of the growing adult TOF population.

Main Methods:

• Review of current literature on imaging techniques for adult TOF.
• Comparison of echocardiography, cardiac magnetic resonance (CMR), and computed tomography (CT) for RV assessment.
• Analysis of the evolution of follow-up strategies from angiography to advanced imaging.

Main Results:

• Echocardiography, CMR, and CT offer distinct advantages and disadvantages for assessing RV in adult TOF.
• Accurate RV volume and function assessment is crucial for determining optimal timing of interventions.
• No single modality is universally superior; a multimodal approach is often necessary.

Conclusions:

• Advanced imaging techniques have largely replaced angiography in the follow-up of adult TOF patients.
• Understanding the strengths and limitations of echocardiography, CMR, and CT is vital for effective patient management.
• Optimizing intervention timing through precise RV assessment improves long-term outcomes for adults with TOF.