Saba Shallal Farhan and Khulood Ghazi Ibrahim
Background: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, affecting 3% per 10,000 live births. Echocardiography and conventional angiography are traditionally used for diagnosis, but they have limitations. Echocardiography’s small acoustic window restricts anatomical evaluation, while cardiac catheterization involves high costs, radiation exposure, invasiveness, and prolonged sedation.
Objective: To evaluate and compare pulmonary artery sizes in unrepaired TOF patients using transthoracic echocardiography, CT angiography, and cardiac catheterization.
Patients & Methods: A cross-sectional study was conducted at Ibn-Al-Bitar Specialized Center for Cardiac Surgery, Baghdad, from April 2022 to April 2023. Fifty pediatric patients with unrepaired TOF underwent transthoracic echocardiography, CT angiography, and cardiac catheterization within 2-3 weeks. Pulmonary artery and pulmonary valve annulus sizes were measured and compared across modalities.
Results: Measurements of the main pulmonary artery, right and left pulmonary arteries, and pulmonary valve annulus by echocardiography (parasternal short-axis view) were significantly smaller compared to CT angiography and cardiac catheterization (p≤0.05). However, CT angiography measurements were not significantly different from those of cardiac catheterization (p>0.05). Strong positive correlations were observed between echocardiography and the other modalities for pulmonary artery sizes (p≤0.05).
Conclusion: Echocardiography is a valid, non-invasive screening and diagnostic tool for pediatric TOF patients. However, it underestimates pulmonary artery sizes compared to CT angiography and cardiac catheterization. CT angiography provides comparable results to cardiac catheterization, making it a reliable alternative for preoperative evaluation.
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