Computed tomography (CT) plays an important supplementary role in the evaluation of patients with congenital heart disease (CHD). Fast multisection spiral CT can be used to obtain isotropic volume data, and high-quality two- and three-dimensional multiplanar reformatted images can be created to accurately and systematically delineate the normal and pathologic morphologic features of the cardiovascular system. CT may be technically challenging and demanding in uncooperative young children. However, it can be used to systematically evaluate the aorta, pulmonary artery, pulmonary vein, cardiac chambers and ventriculoarterial connection, relationship between the upper lobe bronchi and pulmonary arteries, coronary artery, valves, systemic veins (superior vena cava, inferior vena cava, hepatic veins), and visceral situs with a step-by-step approach. This approach may be helpful in understanding the anatomy of the cardiovascular system in CHD patients. CT has both advantages and disadvantages in evaluating patients with CHD. Nevertheless, it is useful in this setting, and radiologists who perform CT in young children with CHD should be familiar with the advantages and disadvantages of CT and with the normal anatomy and typical pathologic conditions in affected patients.

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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.