The following list provides an imaging

focus for adults with repaired TOF: Right Ventricular Z-VAD-FMK price outflow Tract A goal of TOF surgery is to relieve the RVOT obstruction, yet many patients are left with varying degrees of obstruction that may be located in the subpulmonary area, at the level of the pulmonary valve, or more distally in the main or branch pulmonary arteries (PA). Visualization of the entire RVOT is important using specific RVOT long-axis (Figure 1A) and two-chamber RV cine views (Figure 1B). The RV two-chamber view allows visualization Inhibitors,research,lifescience,medical of the right atrium, tricuspid valve, right ventricle, and main pulmonary artery all in one plane. Regardless of the type of repair and whether it involves a transannular or right ventricular patch, RVOT regional

Inhibitors,research,lifescience,medical wall motion abnormalities and aneurysms are common. RVOT aneurysms are not only associated with decreased right ventricular (RV) ejection fraction (EF) but are also associated with unfavorable ventricular interactions, resulting in a reduced left ventricular (LV) EF.8 Assessing for downstream stenosis in the branch PAs can be performed with either a steady-state free precession (SSFP) stack in an axial plane or a magnetic resonance angiogram (MRA). Figure 1. Steady-state free precession images of a patient with tetralogy of Fallot and a transannular patch demonstrating (A) a Inhibitors,research,lifescience,medical large right ventricular outflow tract aneurysm (*) and thrombus in the pulmonary artery (+) in the right ventricular outflow tract view, … Ventricular

Size and Function Accurate quantification of RV size and function is particularly important in repaired TOF patients, as longstanding pulmonary regurgitation (PR) contributes to RV dilation (Figure 2). RV dilatation Inhibitors,research,lifescience,medical and dysfunction are associated with adverse outcomes in this group.9 In adults with repaired CHD, echocardiographic windows are often limited by body habitus and surgical scar tissue. By contrast, CMR provides excellent image quality and is highly reproducible for quantifying RV size and function.10 LV dysfunction is present in >20% of adults with TOF repair, Inhibitors,research,lifescience,medical particularly those who were repaired later in life, had prior palliative shunts, and concomitant RV dysfunction.7, 11 LV dysfunction (LVEF <40%) has been associated with sudden cardiac death in this patient population.12 below Figure 2. Steady-state free precession four-chamber view of a patient with tetralogy of Fallot and severe pulmonary and tricuspid regurgitation with marked right atrial and right ventricular dilation. RA: right atrium; RV: right ventricle; LA: left atrium and LV: … Pulmonary Regurgitation Pulmonary regurgitation (PR) is a common consequence of prior RVOT surgery and may be associated with RV dilation, predisposing to RV dysfunction, arrhythmias, and death. CMR phase contrast sequences assess antegrade and retrograde flow through the main pulmonary artery (Figure 3), and studies demonstrate this to be a highly reproducible technique for quantifying pulmonary regurgitation.