Imaging congenital heart disease in adults

Abstract

ABSTRACT. Transthoracic echocardiography is the first-line modality for cardiovascular imaging in adults with congenital heart disease (ACHD). The windows of access that are possible with transthoracic echocardiography are, however, rarely adequate for all regions of interest. The choice of further imaging depends on the clinical questions that remain to be addressed. The strengths of MRI include comprehensive access and coverage, providing imaging of all parts of the right ventricle, the pulmonary arteries, pulmonary veins and aorta. Cine images and velocity maps are acquired in specifically aligned planes, with stacks of cines or dynamic contrast angiography providing more comprehensive coverage. Tissues can be characterised if necessary, and MRI provides relatively accurate measurements of biventricular function and volume flow. These parameters are important in the assessment and follow-up of adults after repairs for tetralogy of Fallot or transposition of the great arteries and after Fontan operations. The superior spatial resolution and rapid acquisition of CT are invaluable in selected situations, including the visualisation of anomalous coronary or aortopulmonary collateral arteries, the assessment of luminal patency after stenting and imaging in patients with pacemakers. Ionising radiation is, however, a concern in younger patients who may need repeated investigation. Adults with relatively complex conditions should ideally be imaged in a specialist ACHD centre, where dedicated echocardiographic and cardiovascular MRI services are a necessary facility. General radiologists should be aware of the nature and pathophysiology of congenital heart disease, and should be alert for previously undiagnosed cases presenting in adulthood, including cases of atrial septal defect, aortic coarctation, patent ductus arteriosus, double-chambered right ventricle and congenitally corrected transposition.

Spinal Cord Motion: Influence of Respiration and Cardiac Cycle

“…Until now, this had not been sufficiently shown by MRI on segmental levels. Cine-sequence MRI, a common and established cardiac imaging technique [22,23] based on a prospective ECG-triggered k-space segmentation, is applicable to demonstrate cardiac cycle-dependent spinal cord motion [19]. This study was designed to assess the range of physiological spinal cord motion and the influence of respiration in comparison with the physiological influence of heart activity on spinal cord motion at each segmental level within the cervico-thoracic-lumbar spinal canal based on MRI measurements.…”

Association between Anomalous Origin of the Left Main and Accessory Mitral Valve Tissue

“…The literature is poor of cases describing an anomalous origin of the LCA from the non-coronary sinus of Valsalva [3][4][5][6]. Two-dimensional echocardiography, computed tomography angiography and magnetic resonance are the most important diagnostic instruments for the evaluation of the coronary anomalies [7]. The advantage of these techniques is to individuate high risk conditions, or eventual further congenital cardiovascular malformations associated, and to state if the ischemic ECG alterations are related to the anatomical defect or to others coexisting pathological conditions.…”

Non-invasive imaging in congenital heart disease

“…Annual scanning may be needed in these high risk patients. (27) An exception is after deployment of a stent, when a contrast-CT study will provide better assessment of the in-stent lumen and any possible aneurysm formation in the vicinity of the stent. (28) IMAGING IN CONGENITAL HEART DISEASE Spring 2013…”

“…The smaller amount of flow measured in the pulmonary trunk will be equivalent to the systemic flow. (27) …”