Radiologic evaluation of suspected congenital heart disease in adults

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• The population of adults with congenital heart disease (ACHD) is growing in North America.
• Radiologic imaging is essential for assessing and monitoring ACHD patients.
• Chest radiography and echocardiography are initial diagnostic tools.

Purpose of the Study:

• To review the role of advanced noninvasive imaging in the evaluation and surveillance of adults with congenital heart disease.
• To highlight the benefits of magnetic resonance imaging (MRI) and computed tomography (CT) in complex ACHD cases.
• To emphasize the utility of noninvasive imaging in serial evaluations and potentially avoiding cardiac catheterization.

Main Methods:

• Review of current radiologic imaging techniques for ACHD.
• Comparison of chest radiography, echocardiography, MRI, and CT for anatomical and functional assessment.
• Discussion of MRI's advantages, including lack of ionizing radiation and nephrotoxic contrast, and its ability to quantify blood flow.

Main Results:

• MRI and CT are often necessary for complex extracardiac anatomy and vascular relationships in postoperative ACHD patients.
• MRI and CT provide volumetric data for comprehensive cardiac assessment.
• MRI can measure blood flow to quantify shunts, regurgitant fractions, and pressure gradients.

Conclusions:

• Noninvasive imaging techniques, particularly MRI, can evaluate most ACHD lesions and may preclude the need for cardiac catheterization.
• Noninvasive imaging is crucial for the serial evaluation of surgically corrected congenital heart disease patients, many of whom require multiple surgeries.
• MRI offers a radiation-free and nephrotoxic contrast-free imaging option for comprehensive ACHD assessment.