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Imaging in Adult Congenital Heart Disease
Stephanie S Gaydos1, Akos Varga-Szemes, Rochelle N Judd
1*Division of Pediatric Cardiology, Department of Pediatrics †Division of Cardiovascular Imaging, Department of Radiology and Radiological Science ‡Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC.
Insights
Adults with congenital heart disease (CHD) require lifelong monitoring due to late complications. Multimodality imaging is crucial for managing these complex cases, guiding treatment effectively.
Area of Science:
- Cardiology
- Medical Imaging
- Adult Congenital Heart Disease
Background:
- Advances in medical care have led to a growing population of adults with congenital heart disease (CHD).
- Many CHD patients undergo palliative treatment, increasing their risk of late-onset complications.
- Lifelong clinical follow-up with serial imaging is essential for monitoring and managing these complications.
Purpose of the Study:
- To review common conditions in adult CHD and associated late complications.
- To outline clinical questions addressed by imaging in adult CHD.
- To discuss the advantages and disadvantages of various imaging modalities for adult CHD.
Main Methods:
- Review of common adult congenital heart disease conditions and their late complications.
- Analysis of clinical scenarios requiring imaging.
- Evaluation of noninvasive imaging modalities: echocardiography, computed tomography (CT), and magnetic resonance imaging (MRI).
Main Results:
- Imaging adult CHD is challenging due to unique patient anatomy, necessitating case-by-case approaches.
- Knowledge of specific CHDs (e.g., Tetralogy of Fallot, Transposition of the Great Arteries, Coarctation of the Aorta) guides imaging modality selection.
- Echocardiography, CT, and MRI offer distinct advantages for evaluating structural abnormalities and complications in adult CHD.
Conclusions:
- Multimodality imaging plays a vital role in the lifelong management of adults with CHD.
- Tailored imaging strategies are essential for accurate diagnosis and effective treatment of late complications.
- Understanding the strengths and limitations of echocardiography, CT, and MRI optimizes patient care in adult CHD.
Abstract:
There has been tremendous growth in the population of adults with congenital heart disease (CHD) over the last few decades because of advances in medical care. Whereas some cases are cured during childhood, most patients instead undergo palliation, which leaves them at risk for late complications. Lifelong clinical follow-up involving serial multimodality imaging is helpful to monitor and guide the treatment of late complications. Imaging of these individuals is challenging because of their unique anatomy and therefore requires careful consideration on a case-by-case basis. Knowledge of late complications associated with various diseases and surgical palliations provides a basis for selection and interpretation of an appropriate imaging study. This review highlights the most common conditions in adult CHD and the clinical questions that imaging hopes to answer, as well as the advantages and disadvantages of available imaging modalities. We illustrate clinical scenarios and the use of noninvasive imaging modalities including echocardiography, computed tomography, and magnetic resonance imaging, as well as applications in the following CHDs: tetralogy of Fallot, transposition of the great arteries, coarctation of the aorta, shunts, functional single ventricle, and coronary anomalies.
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