Multimodality Cardiovascular Imaging in the Investigation of Decompensated Heart Failure in Patients with Adult Congenital Heart Disease

Abstract

Early diagnosis and advancements in cardiac surgery and interventional cardiology have significantly improved the survival of patients with congenital heart disease. Adults with congenital heart disease (ACHD) are a rapidly growing population. Heart failure is common because many interventions are palliative rather than curative. The heterogeneity of the underlying anatomy, surgical repairs, and the broad spectrum of heart failure causes will require a multimodality cardiac imaging approach for diagnosis and assessment. Different imaging modalities have their strengths and weakness. Selecting the most appropriate imaging method or deciding the suitable combination of imaging modalities depends on the patient's clinical condition and the required clinical information for therapeutic intervention. Echocardiography usually is the first line of imaging. However, image quality is both operator and patient dependent. Cardiac magnetic resonance imaging (CMR) is becoming the next choice in most patients. However, CMR is not appropriate for the critically ill or in the presence of CMR non-compatible implants. Computed tomography (CT) or cardiac catheterization will be the choice. When therapeutic intervention is considered, cardiac catheterization is the selection. The diversity and complexity of the ACHD heart failure population will need an individualized rather than a dogmatic approach in selecting the appropriate imaging. Early diagnosis and advancements in cardiac surgery and interventional cardiology have significantly improved the survival of patients with congenital heart disease. Adults with congenital heart disease (ACHD) are a rapidly growing population. Heart failure is common because many interventions are palliative rather than curative. The heterogeneity of the underlying anatomy, surgical repairs, and the broad spectrum of heart failure causes will require a multimodality cardiac imaging approach for diagnosis and assessment. Different imaging modalities have their strengths and weakness. Selecting the most appropriate imaging method or deciding the suitable combination of imaging modalities depends on the patient's clinical condition and the required clinical information for therapeutic intervention. Echocardiography usually is the first line of imaging. However, image quality is both operator and patient dependent. Cardiac magnetic resonance imaging (CMR) is becoming the next choice in most patients. However, CMR is not appropriate for the critically ill or in the presence of CMR non-compatible implants. Computed tomography (CT) or cardiac catheterization will be the choice. When therapeutic intervention is considered, cardiac catheterization is the selection. The diversity and complexity of the ACHD heart failure population will need an individualized rather than a dogmatic approach in selecting the appropriate imaging.