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Relatively recent advances in pediatric cardiovascular surgery, catheter-based interventional therapies, intensive care, and medical management have dramatically changed the landscape of the field of congenital heart disease (CHD). The complexity of the anatomy and physiology of patients surviving with CHD increases exponentially. The majority will survive to adulthood, and the need for reintervention is common. As such, the field is placing new demands on imaging to diagnose and plan medical management, as well as to identify need for and timing of reintervention. There are a number of imaging modalities available to the clinician and radiologist when it comes to these evaluations.

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Echocardiography (ECG) has been and remains a mainstay of imaging in congenital heart disease. Despite its importance in rapid diagnosis and follow-up, it has limitations. The presence of postoperative scar, chest wall deformities, overlying lung tissue, and large body size as the patient ages often results in suboptimal transthoracic echocardiographic windows. Transesophageal echocardiography provides improved acoustic windows, but is limited by its small field of view and more invasive nature.

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Cardiac catheterization, employing x-ray fluoroscopy and contrast angiography, has an expanding role in minimally invasive interventions, but its role as a diagnostic procedure is rapidly diminishing. This is in part due to its limitation as a 2-dimensional projection imaging technique with poor soft tissue contrast and the substantial ionizing radiation exposure involved and in part because both diagnostic and functional analyses are often better performed with noninvasive imaging techniques.

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This chapter focuses on the evolving and expanding roles of other imaging modalities in diagnosing and monitoring patients with congenital heart disease, including cardiac magnetic resonance imaging (MRI), cardiac computed tomography (CT), and radionucleotide scintigraphy.

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Cardiac magnetic resonance imaging (MRI) has emerged over the past few decades as an alternative, complementary, and frequently superior imaging modality for investigating the anatomy and function in the patient with congenital heart disease. It has many advantages over other imaging modalities. It does not require the use of iodinated contrast agents and does not involve exposure to ionizing radiation. This is particularly important in a population of patients who have been, and continue to be, exposed to large doses of contrast agent and radiation during hemodynamic and interventional catheterization. Additionally, many of these patients are children who are more susceptible to the adverse effects of radiation. Major advances in MRI hardware and software, including advanced coil design, faster gradients, new pulse sequences, and faster image reconstruction techniques, allow rapid, high-resolution imaging of complex anatomy and accurate, quantitative assessment of physiology and function.

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Cardiac MRI Techniques

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There are a number of MRI techniques useful in examining the anatomy and physiology of the congenital heart disease patient.

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Cine MRI

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ECG-gated gradient-echo sequences provide multiple images throughout the cardiac cycle in prescribed anatomic locations. Display of these images in a cine mode allows visualization of the dynamic motion ...

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