Advanced imaging for pre- and post-operative evaluation of tetralogy of Fallot

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease and imaging plays a key role in diagnosis, pre-operative planning and follow up, with MRI as the gold standard for imaging in these patients despite echocardiography being more widely available. While static MRI sequences are suitable for evaluation of anatomical structures, dynamic imaging is required for volume and flow measurements through valves, chambers, and surgical conduits. Newer techniques with 4D data acquisitions allow for feasible 2D cine reconstruction in desired planes. Ferumoxytol, a blood pool contrast agent with long intravascular half-life, facilitates acquisition of 4D flow and 4D MUSIC (multiphase, steady-state imaging with contrast) sequences, eliminating need for repeated contrast administrations. In this article we review conglomerate of TOF anomalies, their historical and current surgical managements with respective devices, as well as cutting-edge MRI techniques for their evaluation.