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 5 publications

(8 citation statements)

References 33 publications

(56 reference statements)

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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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Primary versus staged repair for tetralogy of Fallot in symptomatic neonates: systematic review and meta-analysis

Busro,

Satria,

Safitri

et al. 2024

Cardiol Young

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The choice between primary repair and staged repair strategy for Tetralogy of Fallot remains a subject of debate in clinical practice. This review aims to compare the outcomes and efficacy of two surgical approaches in managing Tetralogy of Fallot among neonatal populations. Literature search was conducted across seven databases, identifying a total of 1393 relevant studies. Inclusion criteria encompassed comparative studies focusing on primary repair and staged repair for Tetralogy of Fallot in neonates. Quality of included studies was assessed using The Newcastle-Ottawa Scale for retrospective cohort studies. Data synthesis involved the extraction of post-operative outcomes. Meta-analysis was performed where feasible, pooling effect sizes to determine the overall impact of each repair strategy. Eight studies were selected for full-text appraisal. A total of 4464 Tetralogy of Fallot patients underwent surgical correction. The pooled mean patient age was 8.68 (±7.38) and 8.56 (±6.8) days for primary repair and staged repair, respectively. The primary repair was associated with a higher cardiac complications rate (odds ratio 1.50, 95% confidence interval 1.07 to 2.10) and transannular patch usage (odds ratio 2.62, 95% CI confidence interval 2.02 to 3.40). In contrast, staged repair was associated with longer hospital (mean difference 11.84, 95% confidence interval 9.59 to 14.10) and ICU (mean difference 3.06, 95% confidence interval 1.64 to 4.47) length of stay. However, no substantial differences were observed in terms of mortality and reintervention rates between these two approaches. The findings highlight the need for well-designed research and emphasise the importance of personalised approaches to address the intricate nature of Tetralogy of Fallot management in this population. Adjusting surgical approach to patient features may be necessary to maximise surgical outcomes.

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

Cited by 5 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

Primary versus staged repair for tetralogy of Fallot in symptomatic neonates: systematic review and meta-analysis

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