Pediatric Cardiology

, Volume 40, Issue 1, pp 161–167 | Cite as

Accuracy of a New Echocardiographic Index to Predict Need for Trans-annular Patch in Tetralogy of Fallot

  • Sowmya Kasturi
  • Seshadri Balaji
  • Abish Sudhakar
  • Gopalraj S. Sunil
  • Brijesh P. Kottayil
  • Praveen Reddy Bayya
  • Raman Krishna KumarEmail author
Original Article


The long-term outcome after repair of tetralogy of Fallot (TOF) is critically dependent pulmonary valve competence that is compromised by trans-annular patch (TAP). We compared a new echocardiographic index [pulmonary annulus index (PAI)] to conventional methods of predicting need for TAP in infants undergoing TOF repair. Consecutive infants undergoing TOF repair were prospectively studied. Pre-operative aortic and pulmonary annuli and main pulmonary artery (MPA) diameters were measured and z scores determined. PAI was a ratio of observed to expected pulmonary annulus (PA) diameter. TAP was based on intra-operative sizing by surgeons blinded to PAI values. Receiver operator curves (ROC) were generated for all PAI, MPA z scores and pulmonary annulus z scores. Of 84 infants (8.6 ± 2.6 months; 7.5 ± 1.3 kg), 36 needed TAP (43%). All the three indices viz. PAI, Pulmonary annulus and MPA z scores performed similarly in predicting need for TAP (ROC curves ~ 80%). Combining cut-offs of MPA z scores (> − 3.83) with either PAI (> 0.73) or PA z score (> − 1.83) predicted avoidance of TAP with ~ 90% accuracy. When both PAI and MPA z scores were below the cut-offs there was an 80% likelihood of TAP. Failure to predict TAP was associated with unicommisural pulmonary valves. PAI was equal to PA z scores in predicting need for TAP during repair of TOF. Combining either with MPA z scores was the most accurate method of prediction. Failure of prediction was mainly due to presence of a unicommissural pulmonary valve.


Congenital heart disease Tetralogy of Fallot Pulmonary valve Echocardiography 



Intensive care unit


Main pulmonary artery


Pulmonary annulus index


Receiver operating characteristic


Right ventricle


Tetralogy of Fallot


Trans-annular patch


Ventricular septal defect


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Pediatric CardiologyAmrita Institute of Medical Sciences and Research Centre, Amrita Vishwa VidyapeethamCochinIndia
  2. 2.Oregon State Health UniversityPortlandUSA
  3. 3.Department of Pediatric Cardiac SurgeryAmrita Institute of Medical Sciences and Research Centre, Amrita Vishwa VidyapeethamCochinIndia

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