Repaired tetralogy of Fallot: the roles of cardiovascular magnetic resonance in evaluating pathophysiology and for pulmonary valve replacement decision support.
Surgical management of tetralogy of Fallot (TOF) results in anatomic and functional abnormalities in the majority of patients. Although right ventricular volume load due to severe pulmonary regurgitation can be tolerated for many years, there is now evidence that the compensatory mechanisms of the right ventricular myocardium ultimately fail and that if the volume load is not eliminated or reduced by pulmonary valve replacement the dysfunction might be irreversible. Cardiovascular magnetic resonance (CMR) has evolved during the last 2 decades as the reference standard imaging modality to assess the anatomic and functional sequelae in patients with repaired TOF. This article reviews the pathophysiology of chronic right ventricular volume load after TOF repair and the risks and benefits of pulmonary valve replacement. The CMR techniques used to comprehensively evaluate the patient with repaired TOF are reviewed and the role of CMR in supporting clinical decisions regarding pulmonary valve replacement is discussed.
Department of Cardiology, Children's Hospital Boston, Department of Pediatrics, Harvard Medical School, Boston, MA, USA. tal.geva@cardio.chboston.org
Tal
T
Geva
D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003661:Decision Support Techniques; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D018579:Patient Selection; D011237:Predictive Value of Tests; D011664:Pulmonary Valve / Q000503:physiopathology / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation; D013771:Tetralogy of Fallot / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D016278:Ventricular Function, Right; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000601:surgery
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