Pediatric cardiac imaging: the beat goes on!

Abstract

The publication of the paper “The accuracy of chest radiographs in the detection of congenital heart disease and in the diagnosis of specific congenital cardiac lesions” [1] provides an opportunity for me to reflect on my career as a pediatric cardiac imager, on past teaching strategies in cardiac imaging, and to comment on the current and future opportunities. I welcome this re-evaluation of cardiac imaging, and the new horizons. Nearly 40 years ago, prior to echocardiography, the gold standard for recognizing children with congenital heart disease consisted of findings on physical examination and a chest radiograph. Traditionally, the radiologist tried to decide based on the chest radiograph whether the infant or child had congenital or acquired heart disease and to suggest a differential diagnosis. Each new generation of residents would learn the list of congenital heart lesions associated with increased, decreased and normal flow, and after asking whether the patient was cyanotic or acyanotic, they would proceed with a list of lesions associated with the flow pattern. Despite the advancement of non-invasive modalities such as echocardiography, CT, and MRI, the approach to teaching and educational programs was based on the assessment of pulmonary flow. Retrospectively, this may have been a flawed approach to cardiac imaging and has resulted in many radiologists not understanding basic physiology and anatomy of the heart.