Congenital heart disease and multi-modality imaging

The increasing prevalence of adult congenital heart disease (CHD) can be attributed to major improvements in diagnosis and treatment of children with CHD. Although, echocardiography is the most commonly used imaging modality for diagnosis and follow up of subjects with CHD, the evolution of both cardiovascular magnetic resonance (MR) imaging and computed tomography (CT) does offer new ways to visualise the heart and great vessels. Cardiovascular MR techniques such as spin-echo and gradient-echo imaging, velocity-encoded phase-contrast MR and gadolinium-enhanced MR angiography allow comprehensive assessment of cardiac anatomy and function. This provides information about the long-term sequelae of the underlying anatomy, haemodynamic assessment of residual post-operative lesions and complications of surgery. Similarly, the development of spiral and subsequently multi-detector CT enables the acquisition of data during a single breath-hold and during the first pass of a contrast bolus, so that images can be reconstructed in any two-dimensional plane or in three-dimensions. As much of the functional data in CHD patients was traditionally acquired with invasive X-ray angiography, non-invasive alternatives such as cardiovascular MR and CT are desirable. This review evaluates the role of imaging modalities in the management of subjects with CHD, particularly detailing recent developments in imaging techniques as they relate to the various CHD diagnoses commonly encountered in practice.