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

Table 4 Examples of scenarios requiring a multimodality diagnostic approach

	Doppler Echocardiography	Cardiac CT	Nuclear Scintigraphy	Cardiac Catheterization
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

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

ISSN: 1532-429X