Cardiovascular magnetic resonance in Tetralogy of Fallot-state of the art

Tetralogy of Fallot (TOF) is the most common type of cyanotic congenital heart disease expressing different severity. There is an increasing survival into adulthood and most patients now experience a good quality of life. Still, complications will develop over time related to the primary surgery and the resulting remodeling of the heart and vessels, which will require reintervention or operation several times during their lives. Imaging plays an increasingly important role in the diagnosis and follow-up of these patients, such as echocardiography as the basic modality, as well as computed tomography angiography (CTA) and cardiac catheterization, providing important anatomical data and the possibility for interventional treatment. Cardiovascular magnetic resonance (CMR) imaging is increasingly used and has a central role in finding the optimal time point for reintervention and provides excellent morphological as well as functional and hemodynamic data that have been proven indicative for reintervention and patient outcome. New MR techniques have been developed providing quantitative information of myocardial tissue characterization, deformation and 4-dimensional phase contrast (PC) imaging technique for advanced blood flow measurements with promising results to provide more refined indications for reoperations and interventions. This review will treat the current role of CMR in the diagnosis and follow up in TOF after repair involving the traditional MR sequences as well as new emerging techniques and their potential role in repaired TOF.