Advanced Cardiovascular Magnetic Resonance Techniques in Grown-Up Congenital Heart Disease

Abstract

Congenital heart diseases comprise a complex population in which functional and anatomic evaluation with cardiac magnetic resonance (CMR) acquires utmost importance in the decision-making process. The use of new CMR technologies can help us understand the physiopathology and improve risk stratification. Efforts towards a better understanding of the processes that underlie the occurrence of adverse events in these patients, mainly heart failure and arrhythmia, have been made in the last years. Early identification of subclinical myocardial involvement by means of detection of changes at the cellular level (fibrosis and extracellular expansion) or impaired ventricular mechanics (deformation techniques) is now possible thanks to late gadolinium enhancement/T1 mapping and strain respectively. Preliminary studies suggest that the presence of fibrosis, either replacement or diffuse fibrosis, and the detection of impaired deformation parameters or significant dyssynchrony are related to outcomes. Assessment of intracardiac and great vessels flow with 4D flow imaging is an attractive research tool that offers a comprehensive evaluation of hemodynamic status and the possibility of obtaining new promising functional parameters.