Three steps approach for preoperative evaluation of tetralogy of Fallot patients: role of 128 MDCT

Moustafa, S.; Hussein, Mohamed S.; Sultan, Amina; Bilal, Maha; Gamal, Mohamed; Sobh, Donia M

doi:10.1186/s43055-021-00418-z

Cited by 4 publications

(8 citation statements)

References 33 publications

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“…Apart from the normal branching pattern, the most common left-sided aortic arch pattern was the bovine arch, including the common origin of the innominate artery and the LCC, which were seen in 40.95% and 16.19% of patients, respectively. These findings are in accordance with those of Moustafa et al (40.4% and 22.8%) [ 29 ] and Tawfik et al (36% and 16%) [ 30 ].…”

Section: Discussionsupporting

confidence: 93%

“…According to the Popieluszko classification, the most frequently seen anomalous arch pattern in our patients was the RAA variant (23.8%). The incidence of RAA has been reported as around 25% in previous studies [ 7 , 18 , 29 ]. Apart from the normal branching pattern, the most common left-sided aortic arch pattern was the bovine arch, including the common origin of the innominate artery and the LCC, which were seen in 40.95% and 16.19% of patients, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Detection of Coronary Artery and Aortic Arch Anomalies in Patients with Tetralogy of Fallot Using CT Angiography

Kakucs¹,

Heidenhoffer

Pop

2022

JCM

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Background: Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease (CHD). Furthermore, the prevalence of anomalous origin of a coronary artery is higher in patients with TOF than in the general population (6% vs. ≤1%). Preoperative assessment of cardiovascular anatomy using computed tomography (CT) angiography enables the adaptation of the surgical approach to avoid potentially overlooked anomalies. Our purpose was to determine the prevalence of coronary artery and aortic arch anomalies in a cohort of TOF patients. Methods: In this retrospective analysis, data were collected from CT reports (2015–2021) of 105 TOF patients. All images were acquired using a 64-slice multi-detector CT (MDCT) scanner. Results: The median age of the patients was 38.7 months, with a male-to-female ratio of 1.39. The overall prevalence of coronary artery anomalies (CAAs) was 7.61% (8 of 105 cases). The anomalous origin and course of coronary arteries across the right ventricular outflow tract (RVOT; prepulmonic course) were defined in 5.71% of cases (six patients). In four of these, the left anterior descending artery (LAD) originated from the right coronary artery (RCA), while in two cases, the RCA arose from the LAD. In the remaining two patients, the coronary arteries followed an interarterial course. The most frequent anomalous aortic arch pattern in the overall TOF population was the right aortic arch (RAA) with mirror image branching, seen in 20% of patients (21 cases). The most frequent anomaly of the supra-aortic trunks was bovine configuration, found in 17.14% (18 cases). Conclusions: The prevalence of CAAs and aortic arch anomalies detected by CT angiography was in line with the data reported in anatomical specimens. Therefore, this technique represents a powerful tool for the evaluation of congenital cardiovascular anomalies.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Detection of Coronary Artery and Aortic Arch Anomalies in Patients with Tetralogy of Fallot Using CT Angiography

Kakucs¹,

Heidenhoffer

Pop

2022

JCM

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“…MPA stenosis/obstruction was observed in 19 individuals, which accounts for 63.3% of the patients, followed by LPA stenosis in 14 patients (46.7%), and RPA stenosis in 10 patients (33.3%). These findings align with the results reported by Moustafa et al [12] and Zakaria et al [10], who stated that the most prevalent pulmonary artery abnormality was combined MPA stenosis and its branches with 17 % incidence. This contrasts with the findings of Sheikh et al [16], the most frequent anomaly reported by 10% of their patients was isolated left pulmonary stenosis.…”

Section: Discussionsupporting

confidence: 92%

“…In our study, MDCT detected the four classic TOF symptoms in 100 percent of cases which corresponds with Shehata et al [11] and Moustafa et al [12] in their research.…”

Section: Discussionsupporting

confidence: 90%

“…This was in line with the findings of Hrusca et al [13], who used non-ECG-gated CT angiography to examine pulmonary artery anomalies in tetralogy of Fallot and discovered that twenty-four patients had infundibular stenosis. Also, Singh et al [14] and Moustafa et al [12] reported that their patients were most affected by infundibular stenosis.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of Aortic Root in Tetrology of Fallot by Multislice Computed Tomography

Abdelwahab

2023

JAMMR

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Background: Tetralogy of fallot (TOF) is the most prevalent cyanotic congenital heart disease (CHD), affecting three out of every 10,000 births. TOF is linked to conal malseptation and lack of rotation, result in failure of the union of the conal and ventricular septa and anterior malalignment of the conal septum, producing the classic tetrad of findings. This work aimed to assess the role of ECG-gated multislice computed tomography (MSCT) in assessing conal malseptation in TOF by measuring the aortic root's clockwise angle rotation, which may serve as a predictor for the degree of conal malseptation and, consequently, the maldevelopment of the right ventricular outflow tract (RVOT). Methods: This prospective study was performed on 30 individuals who underwent MDCT cardiac angiography of the heart and great vessels to confirm the diagnosis or to address specific anatomic questions raised by inconclusive echocardiography findings before planning the appropriate management. The examined cases were classified into two groups: Group 1 (TOF-PS) TOF with pulmonary stenosis (n=20) and Group 2 (TOF-PA) TOF with pulmonary atresia (n=10) .Using a true short-axis view of the aortic valve, the aortic root rotation was determined by drawing a line joining the interleafet anterior commissure and the middle of non-coronary sinus then measuring its angle with the interatrial septum plane. Correlation was done between the rotation angle and main pulmonary artery (MPA) diameter indexed to body surface area. Results: All cases exhibited a rotation of the aortic root in a clockwise direction, with no instances of counterclockwise rotation. The TOF-PA group had a larger rotation angle of the root of the aorta compared to TOF-PS group with a statistical significance difference between the two groups (67.23⁰ ± 13.45⁰ vs 54.34⁰ ± 6.54⁰, P=0.028 respectively). The mean MPA diameter indexed to BSA 12.91 ± 6.05 mm/m2. The angle of aortic root rotation in a clockwise direction was negatively correlated with the indexed MPA diameter with spearman coefficient = -0.325 and p=0.162. A cut-off value of aortic angle of 56.8° was determined, above which there is a risk of pulmonary atresia (AUC=0.750, 95% CI= 0.535 – 0.965) with sensitivity 70%, specificity 65%, positive predictive value of was 50% and negative predictive value was 81.2%. Conclusions: MSCT quantitatively assesses conal malseptation and its impact in individuals with TOF. The aortic root rotates at an angle in the clockwise direction. There is a negative correlation between the degree of aortic root rotation in a clockwise direction and the size of the proximal MPA. Patients diagnosed with TOF with pulmonary atresia (pa) exhibit a greater degree of aortic root rotation.

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320 cardiac MDCT angiography in preoperative assessment of TOF and its variants: Does it worth it?

Elreweny

Dawoud

Mahmoud

et al. 2022

Egypt J Radiol Nucl Med

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Background Tetralogy of Fallot is the most common cyanotic congenital heart disease encountering a large spectrum of anatomical presentations with differing surgical approaches, and long-term outcomes ranging from ventricular septal defect with limited aortic overriding and mild pulmonary obstruction to a critical form of VSD and pulmonary atresia. TOF variants include PA/VSD, TOF/CAVC, TOF/DORV and TOF with absent pulmonary valve. Also, it may be accompanied with many associated intracardiac and extracardiac anomalies that may be of value when imaging and planning the surgical procedure. Results Our study included 22 cases of classic TOF, 18 with PA/VSD (12 were of type A, 5 were of type B and 1 was of type C), 3 with TOF/CAVC and 7 TOF/DORV. Sub-valvular RVOTO was detected in 94% of patients. A statistically significant difference was depicted between Echocardiography and MDCT in detecting supravalvular RVOTO, however no statistically significant difference was found in sub-valvular and valvular RVOTO detection. MDCT could efficiently characterize pulmonary arterial tree with statistically significant difference between both Echocardiography and MDCT in assessment of main, right and left pulmonary arteries with P value = 0.036,0.014 and 0.023 respectively. With calculation of Mc-Goon ratio in all patients, it was favorable (> 1.2) in 33 patients (66%). MDCT entailed 19 patients with PDA versus 15 depicted by Echocardiography and 25 MAPCAs per 11patients compared 8 MAPCAs per 7 patients detected by Echocardiography. Right sided aortic arch was found in 10 patients and 24 patients showed abnormal branching pattern. Coronary artery abnormalities were identified in eight patients. MDCT showed 100% sensitivity and 100% specificity in depicting aortic, coronary and other associated extracardiac vascular anomalies. Conclusion MDCT offers comprehensive anatomical assessment of TOF, and its variants providing superiority over echocardiography and comparable results to cardiac catherization with 100% sensitivity and specificity in evaluation of associated extracardiac vascular anomalies as well as pulmonary arteries characterization. It is worth using MDCT routinely in combination with echocardiography for the preoperative assessment of TOF and its variants representing a less invasive option than conventional catherization with lower radiation exposure.

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Three steps approach for preoperative evaluation of tetralogy of Fallot patients: role of 128 MDCT

Cited by 4 publications

References 33 publications

Detection of Coronary Artery and Aortic Arch Anomalies in Patients with Tetralogy of Fallot Using CT Angiography

Detection of Coronary Artery and Aortic Arch Anomalies in Patients with Tetralogy of Fallot Using CT Angiography

Assessment of Aortic Root in Tetrology of Fallot by Multislice Computed Tomography

320 cardiac MDCT angiography in preoperative assessment of TOF and its variants: Does it worth it?

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