Tetralogy of Fallot(TOF)is a common cyanotic congenital heart disease.Imaging plays a pivotal role in the diagnosis and surgical planning of TOF.Trans-thoracic echocardiography,cardiac computed tomography,and magnetic...Tetralogy of Fallot(TOF)is a common cyanotic congenital heart disease.Imaging plays a pivotal role in the diagnosis and surgical planning of TOF.Trans-thoracic echocardiography,cardiac computed tomography,and magnetic resonance imaging are the commonly used non-invasive imaging modalities.Precise delineation of cardiac anatomy,pulmonary artery status,and associated anomalies is essential to guide the surgeon.Catheter angiography is used in specific situations for surgical planning and also to perform palliative procedures for cyanotic spells.Advances in imaging and surgical techniques have led to a better life expectancy.This has created a population of repaired TOF patients,in whom imaging plays a crucial role in both follow-up and the evaluation of complications.This article reviews the role of imaging modalities in TOF and repaired TOF,touching upon the basics of each modality,which are necessary for pre-operative diagnosis,surgical planning,and post-operative follow-up.The standard surgical strategies are also discussed,as relevant to post-operative imaging findings.展开更多
Introduction: Right ventricular (RV) dysfunction can occur early and late in patients after intracardiac repair (ICR) for Tetralogy of Fallots (TOF). This study focuses on early RV dysfunction as there is limited data...Introduction: Right ventricular (RV) dysfunction can occur early and late in patients after intracardiac repair (ICR) for Tetralogy of Fallots (TOF). This study focuses on early RV dysfunction as there is limited data on it. Aims & Objective: RV function was studied with respect to its incidence, course over 3 months, co-relation with peri operative factors and serum iron levels. Material & Method: All patients of TOF undergoing ICR during July 2007-October 2008, done by single surgeon at a single centre, were prospectively studied. Patients were divided into group A (with RV dysfunction) and group B (without RV dysfunction). All patients underwent pre operative & post operative clinical assessment, biochemical evaluation (serum iron profile & CK MB) and 2D echocardiography (pulse Doppler & tissue Doppler). Echocardiography was done at 24 hours, 4 weeks & 12 weeks of ICR. Patients were also assessed for intra operative parameters including cross clamp time, by pass time, acidosis, RV and PA pressures. Results: 24 patients underwent ICR (transannular patch repair) with mean age of 7.31 ± 4.74 years. RV dysfunction was present in 13 patients (54.2%) but was persistent only in 15.3% (2/13) at 12 weeks. Presence of cyanotic spell (p = 0.006), recurrent chest infection (p = 0.002), raised heamatocrit (p = 0.02), and rise in serum iron level (p = 0.002) were significantly associated with post operative RV dysfunction. It resulted in prolong ICU stay and slower recovery. Pre operative RV dysfunction was associated with difficult weaning from bypass and poor post operative outcome (p < 0.001). Conclusion: RV dysfunction is commonly present even after satisfactory ICR. Its aetiology remains unclear in such setting. In our study, pre operative clinical profile and serum iron fluctuations were important determinants of post operative outcome.展开更多
文摘Tetralogy of Fallot(TOF)is a common cyanotic congenital heart disease.Imaging plays a pivotal role in the diagnosis and surgical planning of TOF.Trans-thoracic echocardiography,cardiac computed tomography,and magnetic resonance imaging are the commonly used non-invasive imaging modalities.Precise delineation of cardiac anatomy,pulmonary artery status,and associated anomalies is essential to guide the surgeon.Catheter angiography is used in specific situations for surgical planning and also to perform palliative procedures for cyanotic spells.Advances in imaging and surgical techniques have led to a better life expectancy.This has created a population of repaired TOF patients,in whom imaging plays a crucial role in both follow-up and the evaluation of complications.This article reviews the role of imaging modalities in TOF and repaired TOF,touching upon the basics of each modality,which are necessary for pre-operative diagnosis,surgical planning,and post-operative follow-up.The standard surgical strategies are also discussed,as relevant to post-operative imaging findings.
文摘Introduction: Right ventricular (RV) dysfunction can occur early and late in patients after intracardiac repair (ICR) for Tetralogy of Fallots (TOF). This study focuses on early RV dysfunction as there is limited data on it. Aims & Objective: RV function was studied with respect to its incidence, course over 3 months, co-relation with peri operative factors and serum iron levels. Material & Method: All patients of TOF undergoing ICR during July 2007-October 2008, done by single surgeon at a single centre, were prospectively studied. Patients were divided into group A (with RV dysfunction) and group B (without RV dysfunction). All patients underwent pre operative & post operative clinical assessment, biochemical evaluation (serum iron profile & CK MB) and 2D echocardiography (pulse Doppler & tissue Doppler). Echocardiography was done at 24 hours, 4 weeks & 12 weeks of ICR. Patients were also assessed for intra operative parameters including cross clamp time, by pass time, acidosis, RV and PA pressures. Results: 24 patients underwent ICR (transannular patch repair) with mean age of 7.31 ± 4.74 years. RV dysfunction was present in 13 patients (54.2%) but was persistent only in 15.3% (2/13) at 12 weeks. Presence of cyanotic spell (p = 0.006), recurrent chest infection (p = 0.002), raised heamatocrit (p = 0.02), and rise in serum iron level (p = 0.002) were significantly associated with post operative RV dysfunction. It resulted in prolong ICU stay and slower recovery. Pre operative RV dysfunction was associated with difficult weaning from bypass and poor post operative outcome (p < 0.001). Conclusion: RV dysfunction is commonly present even after satisfactory ICR. Its aetiology remains unclear in such setting. In our study, pre operative clinical profile and serum iron fluctuations were important determinants of post operative outcome.
