Methodist Journal

IN THIS ISSUE

Adult Congenital Heart Update

Vol 15, Issue 2 (2019)


FEATURED GUEST EDITOR

ISSUE INTRO

The Growing Number of Adults Surviving with Congenital Heart Disease

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RECOGNITIONS

Drs. MacGillivray and Lin Take the Lead in Adult Congenital Heart Disease

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REVIEW ARTICLES See More

Advanced Cardiac Imaging for Complex Adult Congenital Heart Diseases

149 Fontan Conversions

Anomalous Aortic Origin of a Coronary Artery

Pulmonary Valve Replacement for Tetralogy of Fallot

Management of the Adult with Arterial Switch

Ebstein’s Anomaly

Heart Transplantation in Adults with Congenital Heart Disease

Cholesterol: Can’t Live With It, Can’t Live Without It

CASE REPORTS See More

Simultaneous Transfemoral Mitral and Tricuspid Valve in Ring Implantation: First Case Report with Edwards Sapien 3 Valve

Uneventful Follow-Up 2 Years after Endovascular Treatment of a High Flow Iatrogenic Aortocaval Fistula Causing Pulmonary Hypertension and Right Heart Failure

Device-Related Thrombus: A Reason for Concern?

Retained Coronary Balloon Requiring Emergent Open Surgical Retrieval: An Uncommon Complication Requiring Individualized Management Strategies

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

Do I Look Fat in This? Multimodality Imaging Findings of a Cardiac Lipoma

CLINICAL PERSPECTIVES See More

POINTS TO REMEMBER

The Kidney in Congenital Cyanotic Heart Disease

EXCERPTA

Talking Statins with Antonio Gotto

POINTS TO REMEMBER

Lipids and Renal Disease

EXCERPTA

Addressing the Feedback Loop Between Depression, Diabetes, and Cardiovascular Disease

EDITORIALS

Letter to the Editor in Response to “Cardiac Autonomic Neuropathy in Diabetes Mellitus”

Vol 7, Issue 2 (2011)

Article Abstract

An Approach To Imaging Adult Congenital Heart Disease : Pitfalls And Pearls


Article Citation:

Monesha Gupta-Malhotra (2011) An Approach To Imaging Adult Congenital Heart Disease : Pitfals And Pearls. Methodist DeBakey Cardiovascular Journal: April 2011, Vol. 7, No. 2, pp. 18-25.

doi: https://doi.org/10.14797/mdcj-7-2-18

Abstract

Noninvasive cardiovascular evaluation of an adult congenital heart disease (ACHD) patient is a multimodality endeavor that can include chest roentgenograms, electrocardiograms, echocardiography (including stress, three-dimensional, intravascular and intracardiac ultrasound, and transesophageal), cardiac magnetic resonance imaging (CMR), computed tomography angiography (CTA), single photon emission computed tomographic (SPECT) perfusion imaging, and positron emission tomography (PET). The cost-benefit ratio and limitations of each modality should always be considered (Table 1). Adults with ACHD often need repetitive imaging, making them vulnerable to radiation-induced cancer;1, 2 hence, modalities using ionizing radiation should be minimized. A transthoracic echocardiogram remains the initial noninvasive modality of choice due to its real-time imaging capability with excellent temporal resolution and its ability to quickly assess hemodynamics along with anatomic delineation. A transesophageal echocardiogram is extremely helpful in further defining intracardiac anatomy and guiding surgical and interventional procedures. Cardiac magnetic resonance imaging is an adjunctive modality to an echocardiogram because ACHD patients frequently have intra-thoracic abnormalities (e.g., adhesions from multiple cardiac operations and lung disease) that can limit the resolution of the ultrasound beam. A CMR is especially helpful in periodic evaluation of the right ventricle, visceral situs, extracardiac anatomy, lesions of the pericardium, pulmonary veins, systemic veins, pulmonary arteries, and aorta.3 For real-time CMR, special techniques such as echo planar can be used; for hemodynamic evaluation by CMR, techniques like velocity-vector mapping, myocardial tagging, echo planar, and fast gradient echo can be used. Besides excellent spatial resolution, the advantage of CTA over other techniques is an extremely fast acquisition time.4 Furthermore, CTA can replace an invasive procedure such as catheterization and angiography for anatomical diagnosis where hemodynamics is not required, such as the diagnosis of arch or coronary artery anomalies. Nuclear scans such as lung perfusion scans and splenic scans are very helpful in determining differential pulmonary blood flow and splenic function, respectively. Both SPECT and PET are valuable in assessing tissue perfusion and metabolism and help to determine viable versus nonviable myocardium after surgery for hypoplastic left heart syndrome and coronary artery anomaly, after arterial switch operation for d-transposition of great arteries, and in acquired illness such as Kawasaki disease.

Keywords
noninvasive , adult congenital heart disease , ACHD , imaging