Role of multidetector CT in assessment of repaired tetralogy of fallot

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Abstract

The population of adults with repaired tetralogy of Fallot (TOF) is growing, thanks to improvements in the surgical and medical management of this condition. Accordingly, late postrepair complications are important medical concerns in these individuals. Initial surgical repair of TOF typically occurs in infancy, consisting of patch repair of the ventricular septal defect (VSD) and relief of right ventricular outfow tract (RVOT) obstruction. Although patients may remain asymptomatic for several decades, the majority will have progressive pulmonic regurgitation that leads to right ventricular (RV) dilatation and functional deterioration. Other frequently seen complications include branch pulmonary artery stenosis, RVOT an-eurysms, and recurrent VSDs. Cardiac computed tomography (CT) is widely available and, in some cases, is the imaging modality of choice for serial evaluation of TOF patients. CT is particularly useful when magnetic resonance (MR) imaging is contraindicated (eg, in patients with implant-able cardiac devices). Unlike MR imaging, cardiac CT allows excellent visualization of endovascular stents and stent-mounted valves. Retrospective electrocardiographically gated cardiac CT can be used for accurate volumetric and functional analysis of the RV. Comprehensive serial evaluation will assist in determining the need for surgical pulmonary valve repair in the setting of progressive RV dysfunction. Three-dimensional volumetric images are useful for evaluation of stent integrity and aneurysm formation. The radiologist should be familiar with the anatomy of TOF, surgical interventions for repair, and postrepair complications encountered at follow-up imaging of these patients. By extracting the breadth of information obtained with cardiac multidetector CT, the radiologist can play an essential role in the management of adult patients with repaired TOF.

Original languageEnglish (US)
Pages (from-to)1023-1036
Number of pages14
JournalRadiographics : a review publication of the Radiological Society of North America, Inc
Volume33
Issue number4
DOIs
StatePublished - Jul 2013

Fingerprint

Tetralogy of Fallot
Multidetector Computed Tomography
Tomography
Stents
Magnetic Resonance Imaging
Right Ventricular Dysfunction
Pulmonary Valve
Three-Dimensional Imaging
Ventricular Heart Septal Defects
Surgical Instruments
Aneurysm
Dilatation
Anatomy
Equipment and Supplies
Lung
Population

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

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title = "Role of multidetector CT in assessment of repaired tetralogy of fallot",
abstract = "The population of adults with repaired tetralogy of Fallot (TOF) is growing, thanks to improvements in the surgical and medical management of this condition. Accordingly, late postrepair complications are important medical concerns in these individuals. Initial surgical repair of TOF typically occurs in infancy, consisting of patch repair of the ventricular septal defect (VSD) and relief of right ventricular outfow tract (RVOT) obstruction. Although patients may remain asymptomatic for several decades, the majority will have progressive pulmonic regurgitation that leads to right ventricular (RV) dilatation and functional deterioration. Other frequently seen complications include branch pulmonary artery stenosis, RVOT an-eurysms, and recurrent VSDs. Cardiac computed tomography (CT) is widely available and, in some cases, is the imaging modality of choice for serial evaluation of TOF patients. CT is particularly useful when magnetic resonance (MR) imaging is contraindicated (eg, in patients with implant-able cardiac devices). Unlike MR imaging, cardiac CT allows excellent visualization of endovascular stents and stent-mounted valves. Retrospective electrocardiographically gated cardiac CT can be used for accurate volumetric and functional analysis of the RV. Comprehensive serial evaluation will assist in determining the need for surgical pulmonary valve repair in the setting of progressive RV dysfunction. Three-dimensional volumetric images are useful for evaluation of stent integrity and aneurysm formation. The radiologist should be familiar with the anatomy of TOF, surgical interventions for repair, and postrepair complications encountered at follow-up imaging of these patients. By extracting the breadth of information obtained with cardiac multidetector CT, the radiologist can play an essential role in the management of adult patients with repaired TOF.",
author = "Sameer Ahmed and Pamela Johnson and Fishman, {Elliot K} and Stefan Zimmerman",
year = "2013",
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N2 - The population of adults with repaired tetralogy of Fallot (TOF) is growing, thanks to improvements in the surgical and medical management of this condition. Accordingly, late postrepair complications are important medical concerns in these individuals. Initial surgical repair of TOF typically occurs in infancy, consisting of patch repair of the ventricular septal defect (VSD) and relief of right ventricular outfow tract (RVOT) obstruction. Although patients may remain asymptomatic for several decades, the majority will have progressive pulmonic regurgitation that leads to right ventricular (RV) dilatation and functional deterioration. Other frequently seen complications include branch pulmonary artery stenosis, RVOT an-eurysms, and recurrent VSDs. Cardiac computed tomography (CT) is widely available and, in some cases, is the imaging modality of choice for serial evaluation of TOF patients. CT is particularly useful when magnetic resonance (MR) imaging is contraindicated (eg, in patients with implant-able cardiac devices). Unlike MR imaging, cardiac CT allows excellent visualization of endovascular stents and stent-mounted valves. Retrospective electrocardiographically gated cardiac CT can be used for accurate volumetric and functional analysis of the RV. Comprehensive serial evaluation will assist in determining the need for surgical pulmonary valve repair in the setting of progressive RV dysfunction. Three-dimensional volumetric images are useful for evaluation of stent integrity and aneurysm formation. The radiologist should be familiar with the anatomy of TOF, surgical interventions for repair, and postrepair complications encountered at follow-up imaging of these patients. By extracting the breadth of information obtained with cardiac multidetector CT, the radiologist can play an essential role in the management of adult patients with repaired TOF.

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