Abstract
BACKGROUND: Tetralogy of Fallot (TOF) is considered one of the most common surgically repaired congenital heart conditions. Continuous improvements in surgical techniques have aimed at preserving the pulmonary valve (PV). Therefore, evaluating PV morphology and the Right Ventricular Outflow Tract (RVOT) is clinically significant as it is enlightening in selecting therapeutic strategies. This study aims to clarify the practical use of 2D transthoracic echocardiography (TTE) in detecting 2-leaflet valves versus 3-leaflet valves and compare the assessment of PV by 2D TTE with surgical assessment. METHODS: A total of 52 TOF patients scheduled for surgical repair were prospectively included. PV morphology was assessed preoperatively using a novel 2D TTE technique, using subclavicular and subcostal en-face views. Echocardiographic findings were compared with intraoperative surgical visual assessments. Sensitivity, specificity, accuracy, and Cohen's kappa coefficient were calculated to determine the agreement between 2D TTE and surgical findings in identifying the number of cusps of the pulmonary valve. RESULTS: The sensitivity, specificity, and accuracy of echocardiography in identifying bicuspid pulmonary valves using the previously mentioned echocardiographic views were 97.4%, 61.54%, and 88.46%, respectively. Cohen's kappa coefficient was 0.657. The sensitivity, specificity, and accuracy of echocardiography in identifying tricuspid PV using the previously mentioned echocardiographic views were 63.64%, 95.12%, and 84.46%, respectively. The Cohen's kappa coefficient was 0.629. Echocardiography could not detect the mono-cuspid morphology of PV in any case; however, two patients had mono-cuspid PV morphology according to the surgeon's visual assessment. CONCLUSION: 2D TTE can be considered an accurate method for evaluating pulmonary valve (bicuspid vs. tricuspid) in patients with Tetralogy of Fallot when specific views are utilized. CLINICAL TRIAL NUMBER: Not Applicable.