Tetralogy of Fallot With Pulmonary Atresia and Major Aortopulmonary Collateral Arteries: Diagnostic Modalities—The Role of Computed Tomography,Cardiac Magnetic Resonance Imaging,and Three-Dimensional Modeling

Abstract

Cross-sectional imaging modalities facilitate the noninvasive acquisition of anatomic and hemodynamic data in patients with congenital heart disease. This is critical in patients with tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries (TOF PA MAPCAs), who typically undergo multiple surgeries and interventional catheterizations over the course of their lifetime. Advances in cardiac computed tomography (CT) and cardiac magnetic resonance imaging (CMR) have enabled increased spatial resolution imaging and decreased scan times. High spatial resolution datasets provide a comprehensive evaluation of MAPCA anatomy including aortic origin location, lung lobes supplied, and the presence of stenoses. The physiologic data provided by CMR offers a noninvasive assessment of both anatomy and pulmonary blood flow, which can be utilized in decision-making and patient risk stratification. Furthermore, the three-dimensional (3D) datasets acquired by either imaging modality can be used to derive a 3D representation of patient-specific anatomy, visualized in a variety of formats including on-screen volume rendering, 3D prints, digital 3D models, and virtual reality. This article reviews the utility and added value of cardiac CT, CMR, and 3D modeling in the diagnosis and management of patients with TOF/PA/MAPCAs.