Tetralogy of Fallot: Current surgical perspective
Open accessAbstract
Tetralogy of Fallot (TOF) is an important lesion for all pediatric and congenital heart surgeons. In designing the most appropriate operation for children with TOF, the postoperative physiology should be taken into account, both in the short and long term. The balance between pulmonary stenosis (PS) and pulmonary insufficiency (PI) may be critical for preservation of ventricular function. A unified repair strategy that limits both residual PS and PI is presented, along with supporting experimental evidence, a strategy for dealing with coronary anomalies, and comments regarding best timing of operation.
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The growth of pulmonary regurgitation is one of the main drawbacks of transannular patch repair.
“The growth of PR is one of this procedure’s main drawbacks.”
From Multimodality imaging assessment of tetralogy of Fallot: From diagnosis to long-term follow-up (2023) · cites this paper as [44]
In “Relevance for Surgical Technique for TOF” (page unavailable), the paper reports moderate or severe pulmonary insufficiency at discharge in 21 patients with a transannular patch alone, supporting pulmonary regurgitation as a drawback. It reports progression over follow-up only for patients who also received pulmonary valve cusp augmentation, not for the patch-alone group. Thus the claimed growth of regurgitation after transannular patch repair is not fully established. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe VSD in TOF is typically closed using a pericardial/Dacron patch, and if needed, the RVOT is enlarged.
“The VSD is typically closed using a pericardial/Dacron patch, and if needed, the RVOT is enlarged.”
From Multimodality imaging assessment of tetralogy of Fallot: From diagnosis to long-term follow-up (2023) · cites this paper as [44]
The 'Relevance for Surgical Technique for TOF' section says the VSD is closed through the tricuspid valve and describes RVOT enlargement or patch reconstruction when needed. It does not say the VSD is typically closed with a pericardial or Dacron patch; the pericardial patches it describes are for pulmonary valve and RVOT reconstruction. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredDepending on the degree of pre-existing pulmonary stenosis or RVOTO, different techniques for RVOT augmentation may be used.
“Depending on the degree of the pre-existing pulmonary stenosis (PS) or RVOTO, different techniques for RVOT augmentation may be used [44,45].”
From Multimodality imaging assessment of tetralogy of Fallot: From diagnosis to long-term follow-up (2023) · cites this paper as [44]
The ‘Relevance for Surgical Technique for TOF’ section describes avoiding division of the pulmonary annulus when possible and using a transannular patch when it is necessary. The Discussion also distinguishes cusp augmentation from a simple transannular patch according to valve anatomy and technical feasibility. These passages support the use of different RVOT reconstruction techniques, but do not specifically say that the degree of pre-existing PS or RVOTO determines the choice. (LLM, conf=0.81)
Experimental — accuracy not yet measuredExtracardiac conduits can develop pulmonary regurgitation later or function as a tiny conduit as people age.
“Usually valved, these conduits—which may be synthetic or biological—can develop pulmonary regurgitation later on or function as a tiny conduit as people age.”
From Multimodality imaging assessment of tetralogy of Fallot: From diagnosis to long-term follow-up (2023) · cites this paper as [44]
The Discussion says valved homograft and xenograft conduits eventually require replacement because of patient growth and conduit deterioration, supporting the point that a conduit can become too small as a patient grows. It does not specifically say these conduits later develop pulmonary regurgitation; its reports of worsening pulmonary insufficiency concern other valve-reconstruction techniques. (LLM, conf=0.84)
Experimental — accuracy not yet measuredPatients with repaired TOF tend to require multiple pulmonary valve replacements.
“Patients with repaired TOF tend to require multiple PV replacements (PVR), and CMR plays a pivotal role in selecting the correct replacement timing [44,48,49].”
From Multimodality imaging assessment of tetralogy of Fallot: From diagnosis to long-term follow-up (2023) · cites this paper as [44]
The Discussion (page unavailable) says valved homografts and xenografts used for right ventricular outflow reconstruction will eventually need replacement because of growth and deterioration. The Introduction also discusses pulmonary valve replacement after TOF repair. Neither passage establishes that repaired TOF patients generally require multiple pulmonary valve replacements. (LLM, conf=0.82)
Experimental — accuracy not yet measured
Cine or PC sequences can be used to quantify stenosis, blockage, or regurgitation of extracardiac conduits.
“Cine or PC sequences can be used to quantify the stenosis, blockage, or regurgitation of these conduits.”
From Multimodality imaging assessment of tetralogy of Fallot: From diagnosis to long-term follow-up (2023) · cites this paper as [44]
The Experimental Method section (page unavailable) says MRI was used to quantify pulmonary insufficiency in a porcine model. It does not identify cine or PC sequences or say they quantify stenosis, blockage, or regurgitation of extracardiac conduits. (LLM, conf=0.82)
Experimental — accuracy not yet measuredOn CMR cine images, the anterior RVOT wall appears thinned, and pulmonary regurgitation can be visually assessed.
“The anterior RVOT wall is seen to be thinned on CMR cine pictures, and PR can be visually assessed.”
From Multimodality imaging assessment of tetralogy of Fallot: From diagnosis to long-term follow-up (2023) · cites this paper as [44]
The Experimental Method section says MRI was used to quantify pulmonary insufficiency, supporting MRI assessment of regurgitation. It does not say this was a visual assessment on cine images, and no passage found describes thinning of the anterior RVOT wall. (LLM, conf=0.76)
Experimental — accuracy not yet measuredCMR plays a pivotal role in selecting the correct timing of pulmonary valve replacement in repaired TOF.
“Patients with repaired TOF tend to require multiple PV replacements (PVR), and CMR plays a pivotal role in selecting the correct replacement timing [44,48,49].”
From Multimodality imaging assessment of tetralogy of Fallot: From diagnosis to long-term follow-up (2023) · cites this paper as [44]
The Introduction discusses the timing of pulmonary valve replacement in repaired TOF and lists MRI among proposed assessment tools. It also says there is no consensus on the best tools or their importance in decision-making, so it does not establish that CMR plays a pivotal role in choosing the timing. (LLM, conf=0.88)
Experimental — accuracy not yet measuredUsing PC sequences, the pulmonary regurgitant fraction can be measured.
“Using PC sequences, the regurgitant fraction can be measured.”
From Multimodality imaging assessment of tetralogy of Fallot: From diagnosis to long-term follow-up (2023) · cites this paper as [44]
The Experimental Method section (page unavailable) says MRI was used to quantify pulmonary insufficiency and reports a comparison of regurgitant fractions. It does not identify phase-contrast (PC) sequences as the method, so the sequence-specific part of the claim is unsupported. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe RVOT displays normal contractility on CMR pictures captured with bSSFP.
“The RVOT displays normal contractility on CMR pictures captured with bSSFP [44,45].”
From Multimodality imaging assessment of tetralogy of Fallot: From diagnosis to long-term follow-up (2023) · cites this paper as [44]
The Introduction (page unavailable) discusses changes in right-ventricular contractility and lists MRI as a possible assessment tool. The Experimental Method (page unavailable) says MRI measured pulmonary insufficiency and ventricular volumes, while contractility was assessed with catheters. A search for bSSFP and normal RVOT contractility found no passage addressing what the claimed CMR images show. (LLM, conf=0.72)
Experimental — accuracy not yet measuredBright portions of a transannular patch on post-gadolinium LGE images are due to localised fibrosis.
“Additionally, portions of the patch that are bright on post-gadolinium LGE pictures are a result of localised fibrosis [44,45,46,47].”
From Multimodality imaging assessment of tetralogy of Fallot: From diagnosis to long-term follow-up (2023) · cites this paper as [44]
The Introduction mentions interstitial collagen formation and MRI as a possible assessment tool, while the surgical-technique section describes transannular patches. Neither section addresses bright patch regions on post-gadolinium LGE images or attributes them to localized fibrosis (searched: late gadolinium enhancement, bright patch regions, fibrosis, and MRI scar). (LLM, conf=0.75)
Experimental — accuracy not yet measuredOn cine images, a transannular patch appears as an akinetic or dyskinetic zone.
“On the cine pictures, the transannular patch appears as an akinetic or dyskinetic zone.”
From Multimodality imaging assessment of tetralogy of Fallot: From diagnosis to long-term follow-up (2023) · cites this paper as [44]
The surgical-technique section describes how a transannular patch is placed, and the Introduction mentions MRI as a tool for assessing right-ventricular function. Neither passage describes the patch's appearance on cine images. Searches for “akinetic or dyskinetic zone” and for cine-image patch motion found no passage addressing that claim. (LLM, conf=0.73)
Experimental — accuracy not yet measuredQuantification of conduit stenosis, blockage, or regurgitation may be incorrect due to conduit artefacts.
“However, the quantification may be incorrect due to conduit artefacts [37,44].”
From Multimodality imaging assessment of tetralogy of Fallot: From diagnosis to long-term follow-up (2023) · cites this paper as [44]
The Introduction discusses uncertainty about which tools best assess pulmonary insufficiency, and the Experimental Method says MRI was used to quantify it. Neither passage says conduit artefacts can make quantification incorrect. Searches for conduit artefacts and inaccurate MRI measurements found no passage addressing that point. (LLM, conf=0.74)
Experimental — accuracy not yet measured
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Singh, S., Pratap, H., Agarwal, S., Singh, A. K., & Satsangi, D. K. (2011) · Indian Journal of Thoracic and Cardiovascular Surgery · doi:10.1007/s12055-011-0093-5 · Cited by 7 · see citing works
The role of cardiac CT angiography in the pre- and postoperative evaluation of tetralogy of Fallot
Banderker, E., Pretorius, E., & Decker, R. D. (2015) · South African Journal of Radiology · doi:10.4102/sajr.v19i2.899 · Cited by 6 · see citing works
Donahue, C. L., Westman, C. L., Faanes, B., Qureshi, A. M., Barocas, V. H., & Aggarwal, V. (2024) · Catheterization and Cardiovascular Interventions · doi:10.1002/ccd.31016 · Cited by 5 · see citing works
Pulmonic Regurgitation in the Adult Cardiac Surgery Patient
Shillcutt, S. K., Tavazzi, G., Shapiro, B. P., & Díaz‐Gómez, J. L. (2016) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2016.06.033 · Cited by 3 · see citing works
Sugamoto, K., Kurishima, C., Iwamoto, Y., Ishido, H., Masutani, S., Ushinohama, H., Sagawa, K., Ishikawa, S., Nakano, T., Kado, H., et al. (2018) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2018.01.014 · Cited by 3 · see citing works
Samal, S., Sharma, R., Minhas, H., G., G., Agarwal, S., Naqvi, S., & Geelani, M. (2022) · The Cardiothoracic Surgeon · doi:10.1186/s43057-022-00086-3 · Cited by 1 · see citing works
Vo, C., Bushman, G. A., Kleiman, Z. I., & Quiñónez, Z. A. (2023) · Springer eBooks · doi:10.1007/978-3-031-10442-8_22 · Cited by 2 · see citing works
Bushman, G. A. (2017) · Springer eBooks · doi:10.1007/978-3-319-44691-2_19 · Cited by 2 · see citing works
Chest pain due to coronary artery compression in an adult with CHD
Warren, M., Numan, M. T., Mallula, K. K., Greenleaf, C. E., & Uppu, S. C. (2023) · Cardiology in the Young · doi:10.1017/s1047951123004274 · Cited by 1 · see citing works
Conal Septal Morphometrics Can Identify Higher Risk Neonates with Tetralogy of Fallot
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Systemic Arterial-to-Pulmonary Artery Shunt Utilization
Awori, M. N., Ali, M. A. M., & Nabil, M. K. (2018) · Annals of African Surgery · doi:10.4314/aas.v14i2.9
Adult patients with congenital heart disease (GUCH): lights and shadows
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To Assess Cases and Management of CHDS in Given Population- A Clinical Study
Singh, D. V. (2019) · Journal of Medical Science And clinical Research · doi:10.18535/jmscr/v7i12.115
Harfoush, A. (2020) · Radiopaedia.org · doi:10.53347/rid-80158
Molar tooth sign − looking beyond the obvious
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Tetralogy of Fallot Correction in Low Z-scores: Expanding the Use of the Valve-sparing Approach
Gonzales, S. A., Nicolas, R., & Catalan, G. T. (2014) · Philippine Journal of Surgical Specialties · doi:10.61662/pcs_thra8730
Spates, T. N., & Krasuski, R. A. (2024) · Springer eBooks · doi:10.1007/978-3-031-50740-3_4
DEUTSCHE GESELLSCHAFT FÜR PÄDIATRISCHE KARDIOLOGIE UND ANGEBORENE HERZFEHLER e.V.
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Cardiac MRI in Adults with Congenital Heart Disease: A Case Based Approach
Spates, T. N., & Campbell, M. J. (2026) · Springer eBooks · doi:10.1007/978-3-032-02269-1_45
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- Authors
- Karl, T.
- Venue
- Annals of Pediatric Cardiology
- Published
- 2008
- Volume
- 1
- Issue
- 2
- Pages
- 93
- ISSN
- 0974-2069 (ISSN-L)
- PMC
- PMC2840758
- OpenAlex
- W2009958447
- Cited by
- 40
- References
- 42
- Citations by year
- 2026: 1 · 2024: 4 · 2023: 4 · 2022: 1 · 2021: 2 · 2020: 3 · 2019: 3 · 2018: 5 · 2017: 2 · 2016: 1 · 2015: 4 · 2014: 2 · 2013: 2 · 2012: 3
- FWCI
- 0.74
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc-sa
- Locations
- Annals of Pediatric Cardiology (publishedVersion, cc-by-nc-sa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Congenital heart defects research
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiovascular Conditions and Treatments
- Keywords
- tetralogy of Fallot, surgical repair, pulmonary stenosis, pulmonary insufficiency, ventricular function, coronary artery anomalies, timing of surgery, postoperative physiology, pediatric congenital heart surgery
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