Percutaneous Angioplasty of Upstream Right Pulmonary artery stenosis post Tetralogy of Fallot (TOF) repair with use of 3D Multi slice-CT imaging Pankaj.

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Percutaneous Angioplasty of Upstream Right Pulmonary artery stenosis post Tetralogy of Fallot (TOF) repair with use of 3D Multi slice-CT imaging Pankaj Jariwala, Saratchandra Koduganti Journal of Indian College of Cardiology Volume 4, Issue 1, Pages 25-30 (March 2014) DOI: 10.1016/j.jicc.2013.10.003 Copyright © 2013 Indian College of Cardiology Terms and Conditions

Fig. 1 ECG shows RBBB with right ventricular hypertrophy with pressure overload. Journal of Indian College of Cardiology 2014 4, 25-30DOI: (10.1016/j.jicc.2013.10.003) Copyright © 2013 Indian College of Cardiology Terms and Conditions

Fig. 2 a–d: 2 D echocardiography of post Tetrology of Fallot's repair case showing right pulmonary artery stenosis. a: Parasternal long axis view shows intact VSD patch and normal mitral valve in diastole with mild enlargement of the right ventricle. b: Short axis view at the level of the great vessels with color flow mapping showing turbulence across RPA ostium. c: 4 chamber view with color flow mapping shows dilated right atrium and ventricle with eccentric mild tricuspid regurgitation. d: Supra-sternal view with color flow mapping showing turbulence across the right pulmonary artery [RPA]. Journal of Indian College of Cardiology 2014 4, 25-30DOI: (10.1016/j.jicc.2013.10.003) Copyright © 2013 Indian College of Cardiology Terms and Conditions

Fig. 3 a–d: Stepwise construction using the 64 slice CT scan of the angiography of right pulmonary artery stenosis with the help of 3D volume rendering images using ‘Siemens’ Leonardo da Vinci Software’. a–c: 3 D CT Images were created and cardiac structures were cropped to show RPA stenosis for diagnosis and measurement of length (33 mm) and diameter (8.2 mm). d: Perfusion imaging showing hypo perfusion of the entire right lung. Journal of Indian College of Cardiology 2014 4, 25-30DOI: (10.1016/j.jicc.2013.10.003) Copyright © 2013 Indian College of Cardiology Terms and Conditions

Fig. 4 a–d: Percutaneous angioplasty of right pulmonary angioplasty. a: Pulmonary angiogram showing Right pulmonary artery stenosis (arrow). b, c: Through right Femoral approach‘10 × 38 mm’ balloon-expandable stent was positioned over Amplatz stiff guide wire. d: Final RV angiogram showing stent in Place in RPA (arrow) and no residual stenosis. There was no pullback gradient. Journal of Indian College of Cardiology 2014 4, 25-30DOI: (10.1016/j.jicc.2013.10.003) Copyright © 2013 Indian College of Cardiology Terms and Conditions

Fig. 5 a–b: Comparison of gradients pre and post procedure of pulmonary angioplasty of right pulmonary artery. a: CW Doppler interrogation shows gradient across RPA of 79 mm Hg. b: PW interrogation of RPA showed a minimal gradient of 06 mm Hg. Journal of Indian College of Cardiology 2014 4, 25-30DOI: (10.1016/j.jicc.2013.10.003) Copyright © 2013 Indian College of Cardiology Terms and Conditions

Fig. 6 a, b: 2D echocardiography of a case of post Tetralogy of Fallot's undergoing right pulmonary angioplasty. a: Suprasternal view showing stent in situ in the right pulmonary artery [Arrows]. b: Short axis view with color flow mapping showing Stent in RPA and a reduction in turbulence. Journal of Indian College of Cardiology 2014 4, 25-30DOI: (10.1016/j.jicc.2013.10.003) Copyright © 2013 Indian College of Cardiology Terms and Conditions