Imaging considerations in tetralogy of Fallot: A comprehensive review

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.