Larios Guillermo, Friedberg Mark K
Division of Cardiology, Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Curr Opin Cardiol. 2017 Sep;32(5):490-502. doi: 10.1097/HCO.0000000000000426.
Imaging is essential for the management of adults with repaired tetralogy of Fallot (rToF). Echocardiography and cardiac magnetic resonance imaging are the central modalities to assess rToF. Here we review recent literature on imaging rToF, focusing on echocardiography and advances in assessment of cardiac mechanics.
Several two-dimensional, three-dimensional, and Doppler echo parameters have been proposed to assess pulmonary regurgitation, right ventricular volumes and ejection fraction, but most of them still have important limitations in their feasibility and reliability compared to cardiac magnetic resonance (CMR). Myocardial deformation imaging to study ventricular and atrial mechanics, regional function, ventricular-ventricular interactions, and electro-mechanical dyssynchrony has yielded insights into the pathophysiologic mechanisms of right ventricular and left ventricular dysfunction; thereby predicting clinical outcomes and exercise capacity, allowing among others, evaluation of the impact of pulmonary valve replacement (PVR). Emerging technologies are expected to further our understanding of the drivers of dysfunction and guide indications and timing of PVR.
Echocardiography and CMR have complementary and overlapping roles in rToF and contribute to our understanding of its pathophysiology and management.
影像学检查对于法洛四联症修复术后（rToF）成人患者的管理至关重要。超声心动图和心脏磁共振成像（CMR）是评估rToF的主要方式。在此，我们综述近期关于rToF影像学检查的文献，重点关注超声心动图以及心脏力学评估方面的进展。
已提出多种二维、三维及多普勒超声心动图参数用于评估肺动脉反流、右心室容积和射血分数，但与心脏磁共振（CMR）相比，其中大多数在可行性和可靠性方面仍存在重要局限性。用于研究心室和心房力学、局部功能、心室间相互作用以及机电不同步的心肌形变成像，已为右心室和左心室功能障碍的病理生理机制提供了见解；从而预测临床结局和运动能力，其中包括评估肺动脉瓣置换术（PVR）的影响。新兴技术有望进一步加深我们对功能障碍驱动因素的理解，并指导PVR的适应证和时机选择。
超声心动图和CMR在rToF中具有互补和重叠的作用，有助于我们理解其病理生理学及管理方法。
