Diagnosis of congenital heart disease in adults and children

Abstract

An accurate, 3D evaluation of the cardiac and related arterial anatomy is critical for the clinical management of adult and pediatric patients with complex congenital heart disease. 3D imaging has to be able to demonstrate the shapes of, and spatial relationships between, the great arteries, proximal branch pulmonary arteries, and anomalous pulmonary venous or systemic connections. Three-dimensional information about extra-cardiac morphological characteristics may determine subsequent surgical intervention. Magnetic resonance imaging has been recommended by a task force report as the first-choice technique for many congenital heart diseases (Asso ciation of European Pediatric Cardiologists 1998). MRI appears, on initial consideration, to be an ideal technique because there is no radiation burden, which is a substantial advantage, especially in neonates and young children. However, it also suffers various limitations: the major one being the need for prolonged sedation and close monitoring, especially of infants with cyanotic heart disease, whose condition is often unstable. For such patients, intensive-care pediatricians must be present during the MRI examination. Also, the spatial resolution of MR images is lower than that of CT images, which can be a significant drawback for visualization of small anatomical structures. More recently, helical CT has been proposed for 3D anatomical visualization in patients with congenital heart disease (Kawano 2000). Helical technology allows volume acquisition in a short period of time and provides good-quality 3D vascular images, even for neonates and infants. The multi-slice CT technology now available has much faster acquisition times , which substantially reduces respiratory artifacts. Furthermore, image synchronization with the cardiac rhythm is now possible, and this should reduce problems associated with heart motion. In our surgical center, which specializes in congenital heart disease, multi-slice CT with the evolution from 4- to 16- and, very recently, 64-slice technology has rapidly become an important complementary imaging technique for both pre- and post-operative management of patients (Lee 2004). © 2007 Springer-Verlag Berlin Heidelberg.