Sharma A, Subramanian P, Soundararajan R, Maralakunte M, Mallick A, Debi U, Jaswal V, Manoj Kumar R, Singhal M. Imaging considerations in tetralogy of Fallot: A comprehensive review. World J Radiol 2025; 17(12): 112986 [DOI: 10.4329/wjr.v17.i12.112986]
Corresponding Author of This Article
Manphool Singhal, MD, Professor, Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Madhya Marg, Sector 12, Chandigarh 160012, India. drmsinghal74@gmail.com
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
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Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 28, 2025 (publication date) through Dec 29, 2025
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Publication Name
World Journal of Radiology
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1949-8470
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Sharma A, Subramanian P, Soundararajan R, Maralakunte M, Mallick A, Debi U, Jaswal V, Manoj Kumar R, Singhal M. Imaging considerations in tetralogy of Fallot: A comprehensive review. World J Radiol 2025; 17(12): 112986 [DOI: 10.4329/wjr.v17.i12.112986]
Arun Sharma, Pavithra Subramanian, Raghuraman Soundararajan, Muniraju Maralakunte, Uma Debi, Manphool Singhal, Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Abhishek Mallick, Rohit Manoj Kumar, Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Vivek Jaswal, Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
Co-first authors: Arun Sharma and Pavithra Subramanian.
Author contributions: Sharma A and Subramanian P contributed equally to this manuscript and are co-first authors. Sharma A, Subramanian P, Soundararajan R, Maralakunte M, Mallick A, Debi U, Jaswal V, and Kumar RM contributed to writing the original draft; Sharma A and Singhal M contributed to validation and revision; Singhal M contributed to conceptualization.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Manphool Singhal, MD, Professor, Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Madhya Marg, Sector 12, Chandigarh 160012, India. drmsinghal74@gmail.com
Received: August 13, 2025 Revised: September 15, 2025 Accepted: November 4, 2025 Published online: December 28, 2025 Processing time: 136 Days and 21.2 Hours
Abstract
Tetralogy of Fallot (TOF) is a common cyanotic congenital heart disease. Imaging plays a pivotal role in the diagnosis and surgical planning of TOF. Trans-thoracic echocardiography, cardiac computed tomography, and magnetic resonance imaging are the commonly used non-invasive imaging modalities. Precise delineation of cardiac anatomy, pulmonary artery status, and associated anomalies is essential to guide the surgeon. Catheter angiography is used in specific situations for surgical planning and also to perform palliative procedures for cyanotic spells. Advances in imaging and surgical techniques have led to a better life expectancy. This has created a population of repaired TOF patients, in whom imaging plays a crucial role in both follow-up and the evaluation of complications. This article reviews the role of imaging modalities in TOF and repaired TOF, touching upon the basics of each modality, which are necessary for pre-operative diagnosis, surgical planning, and post-operative follow-up. The standard surgical strategies are also discussed, as relevant to post-operative imaging findings.
Core Tip: Transthoracic echocardiography is the basic investigation in assessing pre- and post-repair tetralogy of Fallot patients. Cardiac magnetic resonance imaging is preferred in adult patients in whom all the clinical queries cannot be answered by transthoracic echocardiography, and for the assessment of cardiac functions and quantification of pulmonary regurgitation. Cardiac computed tomography, for all practical purposes, is the workhorse for pre-operative evaluation of relevant surgical anatomy. With advancements in imaging technologies and improved post-operative survival rates, it is essential to be aware of the pre-operative and post-operative appearances of tetralogy of Fallot patients.
