MRI in repaired congenital heart disease

Abstract

Congenital heart disease (CHD) represents the most common form of birth defects and is the leading cause of birth defect-related deaths (Talner et al., Pediatrics 65:375-461, 1980;). Current data suggest that the total incidence for nonchromosomal CHD in the USA is 12 per 1,000 births (). An estimated 6 % of these babies die before the age of 1 year (Hoffman and Kaplan, J Am Coll Cardiol 39:1890-1900, 2002; Hoffman et al., Am Heart J 147:425-439, 2004). As treatment of CHD has improved, there is a need for regular diagnostic follow-up in this growing population across all age ranges (Khairy et al., J Am Coll Cardiol 56:1149-1157, 2010; Marelli et al., Circulation 115:163-172, 2007). Expert guidelines for the definition of care have been developed but are based on limited data, and there is an ongoing debate about indications for surgery or re-intervention and longitudinal evaluation (Warnes et al., J Am Coll Cardiol 52:e1-121, 2008; Sable et al., Circulation 123:1454-1485, 2011). It is therefore crucial to establish efficient methods for the diagnosis, therapy planning, and post-interventional monitoring of CHD in order to provide biomarkers for long-term outcome and longitudinal care. The main needs in CHD are successful early treatment and ongoing care for affected children and adults. Transthoracic and transesophageal echocardiography (TTE and TEE) are readily available imaging options and are the primary modalities for managing patients with CHD (Marelli et al., Cardiol Clin 11:505-520, 1993; Weintraub et al., Circulation 86:711-722, 1992). The major limitation of TTE and TEE is their inability to sufficiently visualize the pulmonary arteries and veins beyond the hilus. In addition, TTE and TEE are limited in their ability to accurately quantify ventricular volumes and blood flow parameters. As patients grow older, acoustic windows often become more restrictive and further limit the diagnostic role of echocardiography.