Imaging of patients with congenital heart disease

Congenital defects most-commonly affect the heart, with an estimated incidence of up to 10 in 1,000 live births. Over the past few decades, mortality has decreased and subsequent survival has increased; approximately 90% of all patients with congenital heart disease (CHD) reach adulthood. Echocardiography is sufficient in most cases for prenatal and postnatal diagnosis of CHD and to plan an intervention, with cardiac MRI and CT providing complementary information on vascular and extracardiac abnormalities. During follow-up, cardiovascular dysfunction is an important cause of reintervention and death. Therefore, routine evaluation of systolic, diastolic, valvular, and vascular function is essential in the care of patients with CHD. Application of echocardiography, cardiac MRI, and CT during follow-up of patients with CHD ideally identifies patients at risk of adverse outcomes, and elucidates the pathophysiological mechanisms that underlie cardiovascular dysfunction. The advent of advanced imaging strategies might further improve the detection of subclinical cardiovascular failure, although further study is required to establish the value of these techniques. Finally, imaging beyond the heart is essential for the complete understanding of the interaction between CHD and noncardiac organ systems, and to extend the success of increased survival to improvements in long-term functional outcome.