Pulmonary Valve Morphology in Congenital Heart Disease with Tetralogy of Fallot Physiology

Background: Tetralogy of Fallot (TOF) is the most common congenital heart disease. It is characterized by pulmonary outflow tract obstruction, ventricular septal defect, overriding of the aortic root, and right ventricular hypertrophy. Anatomy of the pulmonary valve and pulmonary arteries is crucial for operative planning and management of patients with TOF, to prevent postoperative complications and morbidity. Materials and Methods: This was a retrospective cross-sectional study of patients with TOF. Cardiac computed tomography angiography (CTA) was performed on a Siemens Somatom Definition Flash 256 slice Dual Source computed tomography (CT), and the anatomy and morphology of the pulmonary valve and arteries were assessed, and the association between the morphology of the pulmonary valve and pulmonary valvular, arterial, and infundibular stenosis was evaluated. Results: A bicuspid pulmonary valve with vertically oriented cusps was the most common in our study. There was a significant association between the morphology of the pulmonary valve and the degree of valvular stenosis, as well as between the degree of valvular stenosis and the morphology of the main pulmonary artery. No significant association was found between pulmonary valve morphology and infundibular stenosis. Conclusions: Current trends in TOF repair focus on pulmonary valve sparing and augmentation techniques. The choice of valve-sparing options during definitive repair depends on the pulmonary valve anatomy, including valve morphology and size. Cardiac CT angiography allows for a detailed assessment of the pulmonary valve and arteries.