POSSIBILITIES OF MODERN IMAGING MODALITIES IN THE DIAGNOSIS AND
PREOPERATIVE ASSESMENT OF TETRALOGY OF FALLOT
Khasanova K.A.1,2, Ternovoy S.K.2,3, Abramyan M.A.1,4
1 - Morozovskaya Children’s City Clinical Hospital.
2 - Sechenov University.
3 - A.L. Myasnikov Institute of Clinical Cardiology.
4 - Peoples’ Friendship University of Russia. Moscow, Russia.
|
P |
urpose. To evaluate the potential of transthoracic TTE, CT and MRI of the heart in the diagnosis and preoperative planning of tetralogy of Fallot (TF).
Materials and Methods. The study comprised 85 children with an incoming clinical diagnosis of tetralogy of Fallot. The average age of the patients was 8.1 (3.4; 8.1) months. All children underwent TTE, 72 – cardiac CT, 36 – cardiac MRI, 52 – conventional angiography. The capabilities of TTE, Cardiac CT and MRI in identifying surgically important concomitant anomalies were assessed: additional sources of pulmonary circulation, right sided aortic arch, aberrant subclavian artery, anomalies of the coronary arteries, venous return and pulmonary arteries. All results were compared with conventional angiography data and/or intraoperative indicators. The interval between TTE, CT and/or MRI of the heart and the performed conventional angiography or open surgery was less than 10 days.
Results. All three methods showed 100% accuracy in diagnosing tetralogy of Fallot in children. TTE was statistically significantly inferior to cardiac CT in determining the presence of large aortopulmonary collateral arteries in patients with TF (p=0.001). In the diagnosis of anomalies of the aortic arch and its branches, venous return, pulmonary arteries and coronary arteries, the diagnostic accuracy of the method was also lower than that of CT and MRI (p>0.005). Tomographic techniques in determining anomalies of the aortic arch and its branches, pulmonary arteries, venous return and additional sources of pulmonary blood supply had very high rates of diagnostic efficiency (98-100%).
Discussion. The high efficiency and wide application of TTE, CT and MRI of the heart in the comprehensive assessment of tetralogy of Fallot in children and the lack of a unified diagnostic algorithm determine the relevance of comparing the capabilities of non-invasive methods of cardiac imaging in preoperative planning for the correction of this congenital heart defect. Taking into account the development of the transthoracic echocardiography method, there are different points of view on the need for routine use of both tomographic techniques and conventional angiography. The results of studies comparing the capabilities of cardiac imaging methods in assessing surgical risks in children with tetralogy of Fallot are few and ambiguous. In this study, using a sufficient amount of material, we assessed the capabilities of all non-invasive methods (TTE, cardiac CT and cardio-MRI) in assessing surgical risks in children with tetralogy of Fallot up to one year old and in the younger age group as part of primary preoperative planning.
Conclusion. TTE is the primary method in diagnosing tetralogy of Fallot in children, but cannot be considered the final preoperative diagnostic technique, due to limitations in the assessment of combined, surgically important, extracardiac anomalies. Cardiac CT is highly effective in assessing important associated anatomical features in patients with tetralogy of Fallot and can be a definitive
tool in planning surgical correction. Cardiac MRI allows to obtain all the necessary information for planning surgical treatment of tetralogy of Fallot, however, the duration of the study and the long stay of patients under anesthesia require strict justification for the feasibility of using MRI, provided that the child has no contraindications to the administration of radiopaque contrast agents and there is the technical ability to perform cardiac CT in the clinic.
Keywords: tetralogy of Fallot, TOF, cardiac CT, TTE, cardiac MRI, children, congenital heart disease, conventional angiography, pulmonary artery.
Corresponding author: Khasanova K.A., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Khasanova K.A., Ternovoy S.K., Abramyan M.A. Possibilities of modern imaging modalities in the diagnosis and preoperative assesment of tetralogy of Fallot. REJR 2023; 13(4):56-68. DOI: 10.21569/2222-7415-2023-13-4-56-68.
Received: 25.10.23 Accepted: 07.11.23