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  • Review Article
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Imaging of patients with congenital heart disease

Nature Reviews Cardiology volume 9, pages 101–115 (2012)Cite this article

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Abstract

Congenital defects most-commonly affect the heart, with an estimated incidence of up to 10 in 1,000 live births. Over the past few decades, mortality has decreased and subsequent survival has increased; approximately 90% of all patients with congenital heart disease (CHD) reach adulthood. Echocardiography is sufficient in most cases for prenatal and postnatal diagnosis of CHD and to plan an intervention, with cardiac MRI and CT providing complementary information on vascular and extracardiac abnormalities. During follow-up, cardiovascular dysfunction is an important cause of reintervention and death. Therefore, routine evaluation of systolic, diastolic, valvular, and vascular function is essential in the care of patients with CHD. Application of echocardiography, cardiac MRI, and CT during follow-up of patients with CHD ideally identifies patients at risk of adverse outcomes, and elucidates the pathophysiological mechanisms that underlie cardiovascular dysfunction. The advent of advanced imaging strategies might further improve the detection of subclinical cardiovascular failure, although further study is required to establish the value of these techniques. Finally, imaging beyond the heart is essential for the complete understanding of the interaction between CHD and noncardiac organ systems, and to extend the success of increased survival to improvements in long-term functional outcome.

Key Points

  • Over the past few decades, survival has increased among patients with congenital heart disease

  • Advances in echocardiography, cardiac MRI, and CT limit the need for invasive studies

  • Noninvasive imaging at diagnosis assists with planning intervention

  • Monitoring of cardiovascular dysfunction is essential during follow-up

  • Imaging identifies patients who are at risk of adverse outcomes

  • Imaging beyond the heart identifies important noncardiac abnormalities

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Figure 1: Examples of echocardiographic techniques.
Figure 2: Examples of MRI techniques in a boy (aged 16 years) obtained 15 years after correction of tetralogy of Fallot.
Figure 3: Examples of CT images obtained after an extended Ross operation for congenital stenosis of the aortic valve in a boy aged 3 years.
Figure 4: Ventricular–ventricular interaction in tetralogy of Fallot.
Figure 5: Evaluation of diastolic function in patients with pulmonary regurgitation.
Figure 6: Changes after PVR in patients with corrected tetralogy of Fallot.
Figure 7: Evaluation of aortic dimension and function and its relation to valvular and ventricular function.

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Acknowledgements

The authors thank Lucia J. M. Kroft from the Department of Radiology, Leiden University Medical Center, the Netherlands for assistance in the preparation of Figures 2f, 2g, and 3.

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Authors and Affiliations

  1. Department of Pediatric Cardiology, Leiden University Medical Center, P. O. Box 9600, Leiden, 2300 RC, The Netherlands

    Arno A. W. Roest

  2. Department of Radiology, Leiden University Medical Center, P. O. Box 9600, Leiden, 2300 RC, The Netherlands

    Albert de Roos

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Roest, A., de Roos, A. Imaging of patients with congenital heart disease. Nat Rev Cardiol 9, 101–115 (2012). https://doi.org/10.1038/nrcardio.2011.162

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