Essentials of Imaging the Repaired Tetralogy of Fallot Patient

Tetralogy of Fallot is one of the commoner forms of congenital heart disease (CHD) with an incidence estimated at around 1 in 3000 live births. Its prevalence is roughly 5%-10% of all forms of CHD. Although it is a cyanotic disorder at presentation, early surgical repair has led to survival to adulthood in the overwhelming majority of cases. However—as with most repaired CHD—such patients are fixed, not cured, and will inevitably come to the attention of the imaging specialist. This article attempts to describe and summarize the main forms of repaired tetralogy that may be encountered in tertiary hospital imaging practice. The anatomy of different forms of tetralogy is reviewed, and relevant pathophysiology is discussed. Reference is made to 22q11 syndrome, which is often missed or not considered by even specialist congenital physicians, and the alerting features of this condition are reviewed. The benefits and challenges of computed tomography and magnetic resonance imaging in the congenital population are covered, and there is discussion regarding the various approaches to imaging available using these techniques.