Spectrum of changes on cardiac magnetic resonance in repaired tetralogy of Fallot: Imaging according to surgical considerations

Imaging of repaired tetralogy of Fallot (TOF) is one of the common indications for cardiac magnetic resonance (CMR) examinations. With advances in CMR imaging techniques like phase contrast imaging and functional imaging, it has superseded investigations like echocardiography for anatomical and functional assessment of the pathophysiological changes in repaired TOF. Common repair procedures for TOF include infundibulectomy, transannular patch repair and right ventricle to pulmonary artery (RV-PA) conduit. While each of these procedures cause dynamic changes in heart and pulmonary arteries resulting in some expected imaging findings, CMR also helps in diagnosing the complications associated with these repair procedures like pulmonary stenosis, right ventricular outflow tract aneurysm, pulmonary regurgitation, RV-PA conduit stenosis, tricuspid regurgitation, right ventricular failure, and residual ventricular septal defects. Hence, it is imperative for a radiologist to be familiar with the expected changes on CMR in repaired TOF along with some of the common complications that may be encountered on imaging in such patients. •Imaging of repaired TOF is one of the common indications for CMR examinations.•CMR is the workhorse for morphological, functional and hemodynamic assessment.•Common repair procedures include infundibulectomy, transannular patch repair and RV-PA conduit.•MRI also helps in diagnosing the complications associated with these repair procedures.