Original Research

The role of cardiac CT angiography in the pre- and postoperative evaluation of tetralogy of Fallot

Ebrahim Banderker, Elias Pretorius, Rik de Decker
South African Journal of Radiology | Vol 19, No 2 | a899 | DOI: https://doi.org/10.4102/sajr.v19i2.899 | © 2015 Ebrahim Banderker, Elias Pretorius, Rik de Decker | This work is licensed under CC Attribution 4.0
Submitted: 12 June 2015 | Published: 17 December 2015

About the author(s)

Ebrahim Banderker, Department of Diagnostic Radiology, Red Cross War Memorial Children’s Hospital, University of Cape Town, South Africa
Elias Pretorius, Department of Diagnostic Radiology, Tygerberg Hospital, Stellenbosch University, South Africa
Rik de Decker, Division of Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, South Africa


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Abstract

Tetralogy of Fallot (TOF) is the first described and most common cyanotic congenital heart anomaly that generated the first successful surgical palliation procedure and definitive intracardiac repair. Classical TOF comprises the four typical features of right ventricular outflow tract obstruction (RVOTO), right ventricular hypertrophy (RVH), ventricular septal defect (VSD) and aortic dextroposition. Complex forms of the condition include TOF associated with absent pulmonary valve and TOF with pulmonary atresia (TOF-PA) with or without major aortopulmonary collateral arteries (MAPCAs). The pathophysiological understanding that the tetrad is basically the sequel of a singular abnormality of infundibular malformation, with anterior deviation of the infundibular septum, had major surgical consequences that improved survival. Diagnostic and functional imaging play a key role in the clinical and surgical management of patients with TOF. We revisit the role of traditionally employed imaging modalities (echocardiography and cardiac catheterisation) only briefly as these remain within the domain of cardiology practice. The emphasis of the present review is to outline the role of cardiac computed tomographic angiography (CTA) in the evaluation of TOF, with special reference to the technical considerations and best practice recommendations. Cardiovascular magnetic resonance imaging (CMR) is addressed only in passing, as this service is not currently available at our institution.

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