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Table 4 Examples of scenarios requiring a multimodality diagnostic approach

From: Repaired tetralogy of Fallot: the roles of cardiovascular magnetic resonance in evaluating pathophysiology and for pulmonary valve replacement decision support

Cardiac CT Nuclear
All patients • Predicted RV pressure by TR jet velocity
• Valve function and interrogation of atrial and ventricular septa by color Doppler
RV hypertension with RVOT obstruction or branch PA stenosis Predicted RV pressure by TR jet velocity    Consider if (a) possible benefit from PA balloon dilation and/or stent; or (b) transcatheter PV implantation
RV hypertension without RVOT obstruction or branch PA stenosis     Assessment of peripheral branch PA stenoses and pulmonary vascular resistance
Branch PA stenosis without reliable pulmonary flow distribution by CMR    Lung perfusion scan  
Branch PA stenosis with ≤35% flow to one lung     Consideration of balloon dilation with or without stent placement
Contraindications to CMR or large metallic artifacts   • Quantitative evaluation of RV size and function
• Anatomy of RVOT and branch PAs
Age >40 years     Coronary angiography before PVR
Secundum ASD with systemic O2 saturation ≤92%     Hemodynamic assessment ± device closure
  1. ASD = atrial septal defect; PA = pulmonary artery; PV = pulmonary valve; PVR = pulmonary valve replacement; RV = right ventricle; RVOT = right ventricular outflow tract; TR = tricuspid regurgitation