Tetralogy of fallot cardiac catheterization


 * Associate Editors-In-Chief: Priyamvada Singh, M.B.B.S. [mailto:psingh@perfuse.org], Keri Shafer, M.D. [mailto:kshafer@bidmc.harvard.edu];  Assistant Editor-In-Chief: Kristin Feeney, B.S. [mailto:kfeeney@perfuse.org]

Overview
Cardiac catheterization can be performed if the anatomy cannot be evaluated on echocardiography. Although echocardiography is the imaging modality of choice, cardiac catheterization allows confirms the diagnosis and permits collection of additional anatomical and hemodynamic data, including the location and magnitude of right to left shunting, the level and severity of right ventricular outflow obstruction, the anatomical features of the right ventricular outflow tract as well as the main pulmonary artery and its branches. Repair of reidual defects following a repair of Tetralogy (leaking VSD, or residual pulmonic narrowing) can also be undertaken percutaneously in exprerienced centers.

==The(ACC/AHA) recommendations for interventional catheterization in patients with previously repaired Tetralogy of Fallot (DONOT EDIT)==

Class I

1. Interventional catheterization in an ACHD center is indicated for patients with previously repaired tetralogy of Fallot with the following indications:
 * 1. To eliminate residual native or palliative systemic–pulmonary artery shunts. (Level of Evidence: B)
 * 2. To manage coronary artery disease. (Level of Evidence: B)

Class IIa

1. Interventional catheterization in an ACHD center is reasonable in patients with repaired tetralogy of Fallot to eliminate a residual ASD or VSD with a left-to-right shunt greater than 1.5:1 if it is in an appropriate anatomic location. (Level of Evidence: C)

==The(ACC/AHA) recommendations for diagnostic and interventional catheterization for adults With Tetralogy of Fallot (DONOT EDIT)==

Class I

1. Catheterization of adults with tetralogy of Fallot should be performed in regional centers with expertise in ACHD. (Level of Evidence: C)

2. Coronary artery delineation should be performed before any intervention for the right ventricular outflow tract (RVOT). (Level of Evidence: C)

Class IIb

1. In adults with repaired tetralogy of Fallot, catheterization may be considered to better define potentially treatable causes of otherwise unexplained left ventricle (LV) or right ventricle (RV) dysfunction, fluid retention, chest pain, or cyanosis. In these circumstances, transcatheter interventions may include: For ACC/AHA Level of evidence and classes click:ACC AHA Guidelines Classification Scheme
 * 1. Elimination of residual shunts or aortopulmonary collateral vessels. (Level of Evidence: C)
 * 2. Dilation (with or without stent implantation) of RVOT obstruction. (Level of Evidence: B)
 * 3. Elimination of additional muscular or patch margin ventricular septal defect (VSD). (Level of Evidence: C)
 * 4. Elimination of residual atrial septal defect (ASD). (Level of Evidence: B)