The value of myocardial strain imaging in the evaluation of patients with repaired Tetralogy of Fallot: a review of the literature.

Tetralogy of Fallot (ToF) is considered to be the most common, complex, cyanotic congenital heart disease (CHD) representing 7-10% of all congenital heart defects, whereas the patients with ToF are the most frequently operated in their early infancy or childhood. Cardiac magnetic resonance (CMR) consists a valuable imaging technique for the diagnosis and serial follow-up of CHD patients. Furthermore, in recent years, advanced echocardiography imaging techniques have come to the fore, aiming to achieve a complete and more accurate evaluation of cardiac function using speckle tracking imaging modalities. We conducted a review of the literature in order to assess the myocardial deformation of patients with repaired ToF (rToF) using echocardiographic and CMR parameters. Patients with rToF have impaired myocardial strain parameters, that are well standardized either with the use of speckle tracking echocardiography or with the use of CMR imaging. Subclinical left ventricular dysfunction (low GLS) and myocardial dyssynchrony are commonly identified in rToF patients. Impaired left atrium (LA) and right atrium (RA) mechanics are, also, a common finding in this study population, but the studies using atrial strain are a lot fewer than those with LV and RV strain. No studies using myocardial work were identified in the literature, as far as rToF patients are concerned, which makes it an ideal field for further investigation.

"Health-Related Quality of Life in Operated Adult Patients with Tetralogy of Fallot and Correlation with Advanced Imaging Indexes and Cardiopulmonary Exercise Test" A Narrative Review.

Congenital heart diseases (CHD) are considered to be the second leading cause of death during infancy and childhood. However, due to advanced imaging techniques, more than 90% of children with complex CHD survive into adulthood, increasing the prevalence of CHD in the population. Tetralogy of Fallot (ToF) is considered to be the most common, complex, cyanotic CHD. Health is an important determinant of a patient's quality of life and this drove physicians to examine ToF patient's health related quality of life (HRQOL), in order to improve medical and surgical interventions. The purpose of this narrative review was to identify parameters derived through modalities, such as cardiovascular magnetic resonance, echocardiography and cardiopulmonary exercise testing and correlate them with repaired ToF (rToF) patient's perceived HRQOL. It is widely proven that rToF patients have worse physical capabilities than healthy population and this can be safely attributed to their cardiac condition. Unfortunately, rToF population is relatively small, making most of the included trials reliable and unable to uniformly agree to the same results. Further investigation is mandatory in order to discover those parameters that will allow physicians to better understand HRQOL in this population, leading to better medical management and rehabilitation.