Assessment and Grading of Pulmonary Regurgitation Following Tetralogy of Fallot Surgical Repair by Cardiac Magnetic Resonance Imaging

Document Type : Original Article


The Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University


Abstract Background: Pulmonary regurgitation (PR) is a common complication following tetralogy of Fallot (TOF) surgical re-pair. It may lead to right ventricular dilatation and deterioration of right ventricular function. The degree of PR impacts the pul-monary valve replacement (PVR) decision. As echocardiography remains the primary investigation for the assessment of PR, cardiac magnetic resonance (CMR) has been established as the investigation of choice for the accurate quantitative assessment of the degree of PR. Aim of Study: This study aimed to comprehensively assess the role of CMR in the evaluation and grading of PR. It also aimed to assess the role of CMR in the evaluation of the RV size and function which are affected as a consequence of PR. Material and Methods: This prospective study included 36 operated TOF patients. They were evaluated for degree of PR, RV volumes, and function by CMR after performing echocar-diography. Results: In this prospective study, regurgitant volume and fraction were calculated for all cases via phase-contrast MRI. PR was assessed for all cases with 2-dimensional (2D) echo-cardiography apart from one case that could not be assessed. CMR was able to accurately assess and grade PR. A statisti-cally significant difference (p-value=0.009) was observed when comparing the results of both modalities for moderate PR. No statistically significant difference could be observed between both modalities regarding mild (p-value=0.11) and severe PR (p-value=0.381) categories. 11 cases had impaired RV function, 8 of which had severe PR. Conclusions: Both cardiac magnetic resonance and echo-cardiography are able to accurately assess and grade pulmonary regurge following tetralogy of Fallot surgical repair. There was a statistically significant difference between CMR and echo-cardiography regarding the moderate category of pulmonary regurge. There was a positive correlation between the severity of PR and impairment of RV function.