Congenital cardiovascular disease in the adult patient: imaging update

Cardiac MRI: Part 1, cardiovascular shunts

OBJECTIVE

MRI plays an important role in the morphologic and functional evaluation of cardiovascular shunts. Good spatiotemporal resolution, inherent contrast resolution, wide FOV, and multiplanar imaging capabilities make MRI an ideal tool in the investigation of cardiovascular shunts. The velocity-encoded phase-contrast sequence is used in the quantification of a shunt and the steady-state free precession (SSFP) sequence is used in the assessment of the functional impact of a shunt. In this article, the role of MRI in the evaluation of cardiovascular shunts and their respective MRI appearances are described and illustrated.

CONCLUSION

MRI can identify and characterize septal defects, quantify shunts and their impact on cardiac function, and help in the selection of appropriate candidates for percutaneous device placement.

Role and effectiveness of cardiovascular magnetic resonance in the diagnosis, preoperative evaluation and follow-up of patients with congenital heart diseases

The substantial advances in the medical and surgical treatment of congenital heart diseases have dramatically improved patients' life expectancy, as well as increased the number of those needing lifelong monitoring to identify complications and residual defects. Magnetic resonance imaging (MRI) is an ideal imaging modality for the follow-up of these young patients owing to its noninvasiveness, high reproducibility and morphological and functional accuracy. This paper describes the most appropriate MRI techniques and sequences for the study of cardiovascular heart diseases on the basis of an analysis of MRI studies carried out between January 2003 and June 2006 on 274 patients affected by all of the main congenital cardiovascular malformations, as well as a review of the literature. The advantages of MRI with respect to other imaging techniques, the problems encountered and the main clinical applications and indications of MRI, with special reference to the most common disease entities, are then discussed to define the role, the utility and the future perspectives of this imaging technique in the study of congenital heart diseases.

Pre- and postoperative evaluation of congenital heart disease in children and adults with 64-section CT

Although echocardiography is the imaging method of choice for diagnostic, preoperative, and postoperative evaluation of congenital heart disease, computed tomography (CT) is a helpful complementary imaging modality, particularly for postoperative evaluation. A thorough understanding of the normal anatomy and the morphologic features of congenital heart diseases is a prerequisite for choosing the optimal CT technique and achieving an accurate diagnosis. Furthermore, a close collaboration with a cardiologist with special training and expertise in congenital heart diseases is required. A sequential segmental approach should be used in evaluating morphologic features, especially during the review of CT images obtained in patients with rare congenital cardiac defects and in postoperative adult patients. To accurately document and interpret the altered flow conditions in patients with congenital heart disease, knowledge of the wide spectrum of surgical procedures and familiarity with the dedicated protocols for performing 64-section CT are needed.

Computed tomography for the diagnosis of congenital heart disease in pediatric and adult patients

The development of multi-slice spiral computed tomography (CT) has increased the clinical use of cardiac CT imaging in patients with congenital heart disease. Multi-slice CT has the advantages of fast scan speed; high spatial resolution, enabling the acquisition of isotropic volume data; and simultaneous evaluation of airways and lung parenchyma, thus increasing the ability to answer most clinical questions about structural abnormalities in patients with congenital heart disease. When coupled with electrocardiography-gating, multi-slice spiral CT can be used in functional evaluations, including ventricular wall motion, ventricular ejection fraction, and motion of cardiac valves, as well as enabling the performance of high-quality coronary CT angiography. In this article, we review imaging techniques of multi-slice spiral CT and imaging findings in pediatric and adult patients with various congenital heart diseases.

Congenital heart disease in the adult: 2004

The number of newborn infants with congenital heart disease is relatively stable.However, because of marked advances in correction and palliation of these conditions,the great majority will survive into adult life, significantly increasing the number of such patients in our population. Most patients with congenital heart disease, treated or not,will require routine, continued medical observation and, therefore, many radiologists will become involved in their care. Not uncommonly, pertinent clinical information is not provided to the radiologist, particularly when the patient presents to an Emergency Room because of intercurrent disease. In order to interpret the chest film or CT examination and provide a pertinent report, the radiologist must be conversant with the patterns of the more common congenital cardiac anomalies as well as their post-operative appearances and potential complications.