الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Tetralogy of Fallot (TOF) is the first described and most common cyanotic congenital heart anomaly that generated the first successful surgical palliation procedure and definitive intracardiac repair. Classical TOF comprises the four typical features of right ventricular outflow tract obstruction (RVOTO), right ventricular hypertrophy (RVH), ventricular septal defect (VSD) and overriding of the aorta. Complex forms of the condition include TOF associated with absent pulmonary valve and TOF with pulmonary atresia (TOF-PA).
The emphasis of the present study is to outline the role of cardiac computed tomographic angiography (CTA) in the evaluation of TOF, with special reference to the technical considerations and best practice recommendations.
All patients with TOF included in this study were subjected to thorough history taking; complete physical examination with special emphasis on cardiac examination, plain chest x-ray when available, transthoracic echocardiography, and cardiac computed tomography.
This study included twenty patients presented with TOF. Their sex distribution was 9 males and 11 females. The age of patients in the study ranged between two months and 29 years, however, the majority of patient population lies below age of two years which was represented by 17 patients.
Patients were divided into two main groups, those referred for preoperative assessment (n=13), and the rest referred for postoperative follow up (n=7) either after total surgical repair or for assessment of palliative Blalock-Taussig shunts.
Looking at the MDCT studies done for the 20 patients, evaluation was made for the main intra-cardiac morphological features, pulmonary vascular anatomy, associated extra-cardiac lesions, and postoperative sequelae or complications for surgically corrected cases.
In preoperative assessment, MDCT was superior to echocardiography in demonstrating pulmonary artery anatomy as well as extra-cardiac association such as PDA and MAPCAs. Echocardiography was able to delineate intracardiac anatomy, except for patients with pulmonary atresia. MDCT missed ASD in one patient, where it was seen clearly by echocardiography. Seven/13 patients were diagnosed as TOF with classical morphological features; namely right ventricular hypertrophy, infundibular pulmonary stenosis, VSD and overriding Aorta. Five/13 patients; had associated pulmonary valve atresia (TOF/PA). One/13 patient had an ASD in association with morphological features of TOF, detected by echocardiography.
MDCT helped in the diagnosis of associated findings seen in TOF patients, namely: dilated aortic root seen in all thirteen patients, PDA seen in seven patients, while MAPCAs were seen in only two patients and were the source of pulmonary blood flow in these patients who have PA. Also right aortic arch was detected in two patients while bilateral SVC was seen in one patient. Malposed aorta was seen in one patient. Mcgoon ratio was calculated in twelve patients, eight patients had ratio more than 1.8, while four patients had ratio less than 1.8.
Seven/20 patients included in the study were referred for postoperative assessment by MDCT after total surgical repair or for assessment of palliative Blalock Taussig shunts. Two patients were assessed after total surgical repair. Five patients were assessed for Blalock Taussig shunts, two of whom were found to have totally