Multimodality Imaging Across the Lifespan in Repaired Tetralogy of Fallot: Current Evidence and Future Directions.
Authors
Affiliations (8)
Affiliations (8)
- The Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada. Electronic address: [email protected].
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Children's' Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
- University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Division of Cardiology, University Hospitals Leuven, Leuven, Belgium.
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital, Pessac, France.
- Peter Munk Cardiac Centre and Toronto Adult Congenital Heart Disease Program, Toronto General Hospital and Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Hadassah University Medical Center, Jerusalem, Israel.
Abstract
Repaired tetralogy of Fallot (rTOF) is a common condition encountered across pediatric and adult congenital heart disease clinics. Although childhood survival is excellent, patients remain at risk for late complications, including exercise intolerance, arrhythmias, heart failure, and sudden death. Residual lesions, most notably pulmonary regurgitation and right ventricular outflow tract obstruction, drive progressive right and secondary left ventricular remodeling, often necessitating repeat interventions such as pulmonary valve replacement. Multimodality imaging is central to management, enabling risk stratification and informing the optimal timing of reintervention. This State-of-the-Art Review summarizes the current state of the art in multimodality imaging for rTOF across the lifespan, highlighting established and emerging techniques. The authors discuss the roles of 2- and 3-dimensional echocardiography, cardiac magnetic resonance, strain and exercise imaging, ultrafast ultrasound, and advanced cardiac magnetic resonance methods in characterizing ventricular function, remodeling, mechanics, flow dynamics, fibrosis, stiffness, and electromechanical interactions. The authors explore developments in image-based machine learning and computational modeling that support patient-specific intervention planning and personalized care.