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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2017; 27(01): 65-69
DOI: 10.4103/0971-3026.202959
Cardiovascular Imaging

Spectrum of pulmonary valve morphology and its relationship to pulmonary trunk in tetralogy of Fallot

Binita R Chacko
Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
,
George K Chiramel
Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
,
Leena R Vimala
Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
,
Devi A Manuel
Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
,
Elizabeth Joseph
Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
,
K Reka
Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Background: Tetralogy of Fallot (TOF) is a complex congenital heart disease with anatomic variations. Although the pulmonary valve in TOF is abnormal, it has not been studied well, especially on newer imaging modalities such as multidetector computed tomography (CT), which gives excellent anatomic detail. Aims: The aim of this study was to assess the morphology of pulmonary valve in TOF on CT and evaluate its association with the degree of hypoplasia of infundibulum and pulmonary trunk. Materials and Methods: The cardiac CT scans of 30 patients with TOF were reviewed to evaluate the morphology of the pulmonary valve, infundibulum, and pulmonary arteries. Fisher's exact test was performed to examine the association between pulmonary valve morphology and degree of hypoplasia of the infundibulum and pulmonary trunk. Results: 16.7% of patients with TOF had pulmonary atresia. The prevalence of tricuspid, bicuspid, and absent valves were 10%, 53.3% and 6.7%, respectively. In another 13.3% of patients, although valve tissue was present, exact morphology could not be determined on CT. The commissures of 62.5% of the bicuspid valves were at 12 o'clock and 6 o'clock or slightly off the midline. There was statistically significant association between valve morphology and degree of infundibular hypoplasia (P < 0.001) and calibre of pulmonary trunk (P < 0.001). Conclusion: Morphological abnormality of the pulmonary valve is common in TOF. The most common type of pulmonary valve in TOF patients is bicuspid valve with commissures at 12 o'clock and 6 o'clock or slightly off the midline. Fewer cusps of the pulmonary valve are associated with a more severe degree of pulmonary artery hypoplasia.

Keywords

Artery - hypoplasia - pulmonary - tetralogy of Fallot - valve


Publication History

Article published online:
27 July 2021

© 2017. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Garne E, Nielsen G, Hansen OK, Emmertsen K. Tetralogy of Fallot. A population-based study of epidemiology, associated malformations and survival in western Denmark 1984-1992. Scand Cardiovasc J 1999;33:45-8.
  • 2 Brickner ME, Hillis LD, Lange RA. Congenital heart disease in adults. N Engl J Med 2000;342:256-342.
  • 3 Sung SC, Kim S, Woo JS, Lee YS. Pulmonic valve annular enlargement with valve repair in tetralogy of Fallot. Ann Thorac Surg 2003;75:303-5.
  • 4 Hua Z, Li S, Wang L, Hu S, Wang D. A new pulmonary valve cusp plasty technique markedly decreases transannular patch rate and improves midterm outcomes of tetralogy of Fallot repair. Eur J Cardiothorac Surg 2011;40:1221-6.
  • 5 Satyanarayana Rao BN, Anderson RC, Edwards JE. Anatomic variations in the tetralogy of Fallot. Am Heart J 1971;81:361-71.
  • 6 McAleer E, Kort S, Rosenzweig BP, Katz ES, Tunick PA, Phoon CK, et al. Unusual echocardiographic views of bicuspid and tricuspid pulmonic valves. J Am Soc Echocardiogr 2001;14:1036-8.
  • 7 Anagnostopoulos P, Azakie A, Natarajan S, Alphonso N, Brook MM, and Kar TR. Pulmonary valve cusp augmentation with autologous pericardium may improve early outcome for tetralogy of Fallot. J Thorac Cardiovasc Surg 2007;133:640-7.
  • 8 Altrichter PM, Olson LJ, Edwards WD, Puga FJ, Danielson GK. Surgical pathology of the pulmonary valve: A study of 116 cases spanning 15 years. Mayo Clin Proc 1989;64:1352-60.
  • 9 Soto B, Pacifico AD, Ceballos R, Bargeron Jr LM. Tetralogy of Fallot: An angiographic-pathologic correlative study. Circulation 1981;64:558-66.
  • 10 Bharati AH, Naware A, and Merchant SA. Absent pulmonary valve syndrome with tetralogy of Fallot and associated dextrocardia detected at an early gestational age of 26 weeks. Indian J Radiol Imaging 2008;18:352-4.