Assessment Of Congenital Heart Disease Research Articles

Radiation Dose Reduction in Pediatric Cardiac Computed Tomography: Experience from a Tertiary Medical Center

Cardiac CT angiography (cCTA) has become an established method for the assessment of congenital heart disease. However, the potential harmful effects of ionizing radiation must be considered, particularly in younger, more radiosensitive patients. In this study, we sought to assess the temporal change in radiation doses from pediatric cCTA during an 8-year period at a tertiary medical center. This retrospective study included all patients ≤18years old who were referred to electrocardiography (ECG)-gated cCTA for the assessment of congenital heart disease or inflammatory disease (Kawasaki disease) from November 2004 to September 2012. During the study period, 95 patients were scanned using 3 different scanner models-64-slice multidetector CT (64-MDCT) and first- (64-DSCT) and second-generation (128-DSCT) dual-source CT-and 3 scan protocols-retrospective ECG-gated helical scanning (RG), prospective ECG-triggered axial scanning (PT), or prospective ECG-triggered high-pitch helical scanning (HPH). Effective dose (ED) was calculated with the dose length product method with a conversion factor (k) adjusted for age. ED was then compared among scan protocols. Image quality was extracted from clinical cCTA reports when available. Overall, 94% of scans were diagnostic (80% for 64-slice MDCT, 93% for 64-slice DSCT, and 97% for 128-slice DSCT).With 128-DSCT, median ED (1.0 [range 0.6-2.0] mSv) decreased by 85.8% and 66.8% compared with 64-MDCT (6.8 [range 2.9-13.6] mSv) and 64-DSCT (2.9 [range 0.9-4.1] mSv), respectively. With HPH, median ED (0.9 [range 0.6-1.8] mSv) decreased by 59.4% and 85.4% compared with PT (2.2 [range 0.9-3.4] mSv) and RG (6.1 [range 2.5-10.6] mSv). cCTA can now be obtained at very low radiation doses in pediatric patients using the latest dual-source CT technology in combination with prospective ECG-triggered HPH acquisition.

Pediatric Echocardiography: New Developments and Applications

In this Special Issue of the Journal, 6 review articles that represent the new developments and applications of echocardiography for diagnosis and assessment of congenital heart disease from fetus to adult are included. The goal is to provide an updated review of the evidence for the current and potential use of some of the new methodologies, i.e. fetal echocardiography, tissue Doppler imaging, strain imaging by speckle tracking imaging, ventricular synchrony, quantification using real time three-dimensional (3D) echocardiography, and 3D echocardiography for adults with congenital heart disease. We hope this effort will provide an impetus for more investigation and ultimately clinical application of these new methodologies to improve the care of those with congenital and acquired heart diseases in the pediatric population and beyond.

Cardiac CT in the Diagnosis and Postoperative Assessment of Congenital Heart Disease

Patients with complex congenital heart disease require serial diagnostic evaluation throughout their lives. Although echocardiography and cardiac MRI are the primary modes of evaluation in the current era, cardiac computed tomography (CT) plays an increasingly important role for specific indications. The high temporal and spatial resolution of the most modern CT scanners used for cardiac imaging allows for rapid, high quality image acquisition. The decreased need for sedation and anesthesia combined with recent developments markedly reducing radiation exposure make it an ideal imaging modality for certain indications in congenital heart disease. This article will briefly review the current use of noninvasive diagnostics in congenital heart disease, focusing on the use of CT for the most common congenital heart lesions referred for surgical intervention. When used appropriately, CT angiography (CTA) can provide critical information necessary to care for patients with congenital heart disease who require evaluation in addition to echocardiography.

Steady-state magnetic resonance angiography of the thoracic vasculature in congenital heart disease using a blood pool contrast agent: evaluation of two different techniques

Background Although contrast-enhanced first-pass MRA (FP-MRA) is frequently used to visualize the vasculature, it may not be suitable for the assessment of congenital heart disease. Blood-pool contrast agents remain within the intravascular space for several hours, allowing vessels to be imaged without relying on accurate contrast bolus timing. The purpose of this study is to compare steadystate magnetic resonance angiography (SS-MRA) following injection of a blood-pool contras agent to first-pass MR angiography (FP-MRA) in adults with congenital heart disease.

Real Time Three-Dimensional Echocardiography for Evaluation of Congenital Heart Defects: State of the Art

Real time three-dimensional echocardiography (RT3DE) has been increasingly used in the diagnosis and assessment of congenital heart disease. A growing body of literature suggests that this new technology can be used as an integrated approach to assess the morphology of simple and complex congenital heart defects, flow abnormality, and left, right, and single ventricular function both qualitatively and quantitatively. This review summarizes the available evidence for the use of RT3DE in each of these areas. Future technology refinement in RT3DE and development of practice guidelines will increase the utilization of this new technology as a valuable tool to compliment 2D echocardiography/Doppler in clinical care and research to improve the care and outcome of congenital heart disease.

Rapid Flow Assessment of Congenital Heart Disease with High-Spatiotemporal-Resolution Gated Spiral Phase-Contrast MR Imaging

To validate a prospectively triggered spiral phase-contrast magnetic resonance (MR) sequence accelerated with sensitivity encoding (SENSE) in a population of children and adults with congenital heart disease. The local research ethics committee approved this study, and written consent was obtained from all patients or guardians. Stroke volumes were quantified in 40 patients (mean age ± standard deviation: 21.4 years ± 13.8, age range: 3.0-61.3 years; 22 male patients aged 3.0-38.0 years [mean age, 17.2 years ± 10.5], 18 female patients aged 4.7-61.3 years [mean age, 26.6 years ± 15.9]) with congenital heart disease in the aorta (n = 40), main pulmonary artery (n = 38), right pulmonary artery (n = 22), and left pulmonary artery (n = 24). Stroke volumes were obtained with (a) breath-hold spiral phase-contrast MR imaging with SENSE, (b) conventional breath-hold cartesian phase-contrast MR imaging, and (c) reference free-breathing phase-contrast MR imaging. Stroke volumes were compared by using repeated-measures analysis of variance, Bland-Altman analysis, and correlation coefficients. Imaging time with the breath-hold spiral phase-contrast MR sequence was significantly lower than that with the conventional breath-hold phase-contrast MR sequence (~5 seconds vs ~16 seconds, respectively; P < .0001). There was excellent agreement in stroke volumes in all vessels between the reference free-breathing sequence (mean volume, 60.3 mL ± 27.3) and the two breath-hold sequences-spiral SENSE phase-contrast MR imaging (mean volume, 59.5 mL ± 27.1; P < .001) and conventional cartesian phase-contrast MR imaging (mean volume, 59.8 mL ± 27.6; P = .268). The limits of agreement were smaller with the spiral breath-hold sequence than with the conventional breath-hold sequence (-4.4 mL, 2.9 mL vs -10.3 mL, 9.3 mL, respectively); correlation was similar (r = 0.998 vs r = 0.984, respectively). Flow volumes can be accurately and reliably quantified by using a spiral SENSE phase-contrast MR sequence, with high spatiotemporal resolution obtained in a short breath hold.

Development of Pediatric Cardiology in Latin America

Until the first quarter of the 20th century, most physicians were more than happy to differentiate congenital heart lesions from rheumatic heart disease, which then was rampant. As early as 1932, Dr Rodolfo Kreutzer, from Buenos Aires, Argentina, was already involved in the study of congenital heart defects. He started off assessing children with a stethoscope and with Einthoven electrocardiography equipment. The cardiac unit at the Buenos Aires Children's Hospital was created in 1936. It established the onset of pediatric cardiology in Argentina and fueled its development in South America. Nearly at the same time, Agustin Castellanos from Cuba also became a pioneer in the assessment of congenital heart disease. He described the clinical applications of intravenous angiocardiography in 1937. Meanwhile in Mexico, Dr Ignacio Chavez founded the National Institute of Cardiology in 1944 in Mexico City. It was the first center in the world to be exclusively devoted to cardiology. From this center, Victor Rubio and Hugo Limon performed the first therapeutic cardiac catheterization in 1953. Meanwhile, Professor Euriclydes Zerbini from Sao Paulo, Brazil, built the largest and most important school of cardiac surgeons in South America. In Santiago, Chile, the Calvo Makenna Hospital was the center where Helmut Jaegger operated on the first infant with extracorporeal circulation in Latin America in 1956. The patient was a 1-month-old baby, with complete transposition of the great arteries, who underwent an Albert procedure. Currently, there are many fully equipped centers all over the region, capable of dealing with most lesions and of providing excellent medical, interventional, and surgical treatment. Outcomes have improved substantially over the last 20 years. These achievements have gone beyond our pioneers' dreams. However, many neonates and young infants die prior to surgery because referral centers are overburdened and have long surgical waiting lists. Clearly, we still have to mastermind and establish sustainable public health policies to overcome these challenges.

Application of MR Imaging in Assessment and Follow-up of Congenital Heart Disease in Adults

Increasing numbers of patients with congenital heart disease survive into adulthood as a result of improved medical and surgical care. This group of patients requires regular ongoing assessment in specialist centers with a multidisciplinary approach. Imaging has an essential role in monitoring disease and treatment. Magnetic resonance (MR) imaging is the modality of choice because it provides data for a functional assessment and excellent morphologic detail. Among the patients who have congenital cardiac conditions, many will have undergone corrective surgical procedures that require specific tailoring of the MR imaging examination. This review highlights the spectrum of such congenital conditions and demonstrates how MR imaging is invaluable in the ongoing assessment of congenital heart disease in adults. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.e40/-/DC1 © RSNA, 2010

Multimodality Noninvasive Imaging for Assessment of Congenital Heart Disease

Major advances in the field of pediatric cardiology and cardiac surgery over the last several decades have led to a dramatic improvement in survival rates for most forms of congenital heart disease (CHD). For example, hypoplastic left heart syndrome, a previously lethal defect, now has early survival rates up to 90% at major centers.1 These improved outcomes have produced a growing population of survivors with complex CHD who are now reaching adulthood (Figure 1). During this period, improvements in surgical and medical treatments have been accompanied by developments in diagnostic modalities. Echocardiography has replaced catheterization as the primary diagnostic modality, and it is now uncommon for newborn infants to undergo catheterization for purely diagnostic purposes. Although echocardiography remains the bedrock of noninvasive cardiac imaging, the array of diagnostic modalities and techniques available continue to grow and this has spawned the specialty of “noninvasive cardiac imaging” and the need for the “cardiac imager” to be adept in all the different modalities. Figure 1. Percentage of patients under the age of 1 year (grey bars) and over the age of 18 years (black bars) undergoing echocardiography at Children’s Hospital Boston from 1983 through 2006. Note the reverse trends of these age groups reflecting the steady increase in the proportion of adult patients with congenital heart disease. Although the absolute number of infants undergoing echocardiography during this time period has increased, their proportion has steadily declined. Echocardiography, cardiac magnetic resonance (CMR), and cardiac computed tomography (CCT) are the primary modalities used for noninvasive cardiac imaging in patients with CHD. Nuclear scintigraphy is used in selected circumstances. The Table summarizes the strengths and weaknesses of each modality. Figure 2 shows temporal trends in utilization for the various noninvasive cardiac imaging techniques at our center. It is clear that echocardiography is the most frequently …

Use of Cardiovascular Magnetic Resonance Imaging in Acute Coronary Syndromes

The clinical role of cardiovascular magnetic resonance (CMR) continues to expand,1 supported by ongoing technological advances that have shortened acquisition times while maintaining and often improving image quality. New applications of CMR in cardiovascular imaging continue to emerge, and results from larger clinical trials are beginning to define the role of CMR in a range of clinical scenarios. Currently accepted indications for CMR include the assessment of congenital heart disease, the great vessels, acquired myocardial and pericardial disease, and chronic coronary artery disease (CAD).1 The role of CMR in the assessment of acute coronary syndromes (ACS) is less well established. However, evidence is accumulating that CMR provides often unique information in chest pain syndromes that can aid in the detection and differential diagnosis of ACS, guide clinical decision making, and improve risk stratification after an event. After reviewing the relevant CMR methodology, the present article puts forward the current evidence for CMR in ACS and gives an outlook of future developments. The following CMR methods are most commonly used to assess ACS (Figure 1) and can be incorporated into a clinical protocol that can be performed within an hour. Figure 1. A, CMR methods for assessment of ACS. Short-axis views (of different patients) illustrate the different imaging techniques used (rows 1 and 2), their morphological correlates (row 3), and main clinical application (row 4). B, These methods can be integrated into a CMR protocol in the sequence indicated to provide a comprehensive assessment of ACS patients. Such a study can be performed in less than 1 hour. Gd indicates gadolinium. ### Cine Imaging The assessment of global and regional left ventricular (LV) and right ventricular (RV) function by CMR is typically based on a cine data set aligned in the true LV short axis that covers the heart in 10 to …

Assessment of congenital heart disease (CHD): Is there a role for fetal magnetic resonance imaging (MRI)?

Purpose To review our experience with fetal magnetic resonance imaging (MRI) to evaluate congenital heart disease (CHD). Methods We performed fetal MRI in 32 fetuses with an echocardiographically assessed CHD. Both direct and indirect signs of CHD were investigated. Direct signs considered were: morpho-volumetric abnormalities of the heart; malrotations; ventricular and atrial septal defects; anomalies of the origin, size and course of the great arteries. Indirect signs considered were: difficulty to recognize a “normal” anatomical structures in the reference projections; increase of the vascular size before a stenosis; hypertrophy of the papillary muscles; cardiomegaly and pericardial effusion. All MRI findings were compared with postnatal or autoptic findings. Results MRI allowed the CHD to be visualised by direct signs in 17 fetuses, indirect signs in 5 and both direct and indirect signs in 9 fetuses, excluding the prenatal echocardiographic suspect of hypoplastic left heart syndrome in 1 fetus. Postnatal echocardiograms or autoptic findings confirmed a normal heart in 1 fetus and CHD in 31 fetuses including a single cardiac anomaly or syndrome in 19 fetuses, 2 associated cardiac abnormalities in 11 and 3 cardiac anomalies in 1 fetus. However, in 2 fetuses MRI detected a ventricular septal defect successively disclosed by gold standard. Conclusions MRI is a promising method for further assessment of the cardiovascular pathologies diagnosed by echocardiography, and may be a valuable tool in assessing associated extracardiac anomalies.

ACCF/AHA/AAP Recommendations for Training in Pediatric Cardiology. A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence (ACC/AHA/AAP Writing Committee to Develop Training Recommendations for Pediatric Cardiology)

HomeCirculationVol. 112, No. 16ACCF/AHA/AAP Recommendations for Training in Pediatric Cardiology. A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence (ACC/AHA/AAP Writing Committee to Develop Training Recommendations for Pediatric Cardiology) Free AccessReview ArticlePDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBACCF/AHA/AAP Recommendations for Training in Pediatric Cardiology. A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence (ACC/AHA/AAP Writing Committee to Develop Training Recommendations for Pediatric Cardiology) Originally published18 Oct 2005https://doi.org/10.1161/CIRCULATIONAHA.105.170308Circulation. 2005;112:2555–2580 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Brucia R, Taggart N, Sagiv E, Kohli U, Tisma-Dupanovic S, Sutton N, McDaniel G, Rossano J, Dwyer A and Marshall A (2022) Applying Practice Analysis to Develop a New Test Content Outline for the Pediatric Cardiology Certification Examination, Pediatric Cardiology, 10.1007/s00246-022-03070-0 Kailin J, Kyle W, Altman C, Wood A and Schlingmann T (2020) Online Learning and Echocardiography Boot Camp: Innovative Learning Platforms Promoting Blended Learning and Competency in Pediatric Echocardiography, Pediatric Cardiology, 10.1007/s00246-020-02494-w, 42:2, (389-396), Online publication date: 1-Feb-2021. Cohen M and Jacobs J (2021) In Memoriam: Paul Morris Weinberg, MD, Cardiology in the Young, 10.1017/S1047951121000123, 31:1, (1-10), Online publication date: 1-Jan-2021. Neal A, Lehto E, Miller K, Ziegler C and Davis E (2017) Using a statewide survey methodology to prioritize pediatric cardiology core content, Congenital Heart Disease, 10.1111/chd.12559, 13:1, (147-153), Online publication date: 1-Jan-2018. Frank L (2017) Domains, competencies, EPAs, and training guidelines: A primer on developments in pediatric cardiology education, Progress in Pediatric Cardiology, 10.1016/j.ppedcard.2017.01.002, 44, (3-10), Online publication date: 1-Mar-2017. Frank L, Koenig P and Srivastava S (2017) Connecting milestones to observable clinical performance through standardized pediatric cardiology rotation evaluations: Report and reflections on a novel pilot project, Progress in Pediatric Cardiology, 10.1016/j.ppedcard.2016.12.005, 44, (11-15), Online publication date: 1-Mar-2017. McCormack J, Seslar S, Wolff G, Young M, Bryant R, Neghme R, Fishberger S, Decker J, Sokoloski M, Ho J, Lawrence D, Jenkins C, Stannard K, Schiebler G, Blanchard W and Jacobs J (2014) Development of paediatric electrophysiology standards for Florida Children’s Medical Services, Cardiology in the Young, 10.1017/S1047951114002066, 24:6, (1134-1149), Online publication date: 1-Dec-2014. da Cruz E, Lechner E, Stiller B, Munoz R, Beghetti M, Fakler U and Haas N (2011) Recommendations from the Association for European Paediatric Cardiology for training in paediatric cardiac intensive care, Cardiology in the Young, 10.1017/S1047951111000655, 21:4, (480-484) Cassalett G (2010) El cuidado intensivo cardiovascular pediátrico en colombia, Revista Colombiana de Cardiología, 10.1016/S0120-5633(10)70217-5, 17:2, (39-40), Online publication date: 1-Mar-2010. Prakash A, Powell A and Geva T (2010) Multimodality Noninvasive Imaging for Assessment of Congenital Heart Disease, Circulation: Cardiovascular Imaging, 3:1, (112-125), Online publication date: 1-Jan-2010. October 18, 2005Vol 112, Issue 16 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.105.170308PMID: 16230506 Originally publishedOctober 18, 2005 PDF download Advertisement

Cardiovascular magnetic resonance and the role of adenosine pharmacologic stress

As an advanced imaging modality, cardiovascular magnetic resonance (CMR) offers high spatial resolution and produces unsurpassed images of the heart and its function. Clinically, CMR is well established in the assessment of congenital heart disease, the aorta, tumors, the pericardium, cardiac mass and function, flow measurement, and the structure and function of the right ventricle. CMR has demonstrated a high interstudy reproducibility of left ventricular volumes, ejection fraction, and mass, making it the ideal noninvasive technique for serial measurements. CMR growth areas that are nearing routine clinical application are the evaluation of myocardial perfusion, infarction, and viability. In perfusion CMR studies, pharmacologic stress is used to increase differences in the first-pass delivery of the contrast agent between myocardial regions perfused by normal and diseased arteries. The most widely used stress modality for CMR perfusion studies is adenosine.

Advances in fetal cardiac imaging.

During the past 25 years, two-dimensional imaging of the fetal heart has evolved into a sophisticated and widely practiced clinical tool, but most heart disease still goes undetected until sometime after birth, despite routine fetal ultrasound evaluations. Over the next 25 years, tremendous advances in fetal cardiac imaging, including three-dimensional imaging, promise to revolutionize both the prenatal detection and diagnosis of congenital heart disease. Image resolution continues to improve year after year, allowing earlier (10-15 week) visualization of the fetal heart, as well as the detection of subtle valvar abnormalities that may progress to serious forms of ventricular hypoplasia at term. However, fetal cardiac imaging remains constrained by limited sonographic windows. To improve the prenatal detection of congenital heart disease, outflow tracts are increasingly included along with the routine screening four-chamber view. However, while the four-chamber view resides within a single plane, lending itself to tomographic evaluation with two-dimensional ultrasound, the outflow tracts (and most forms of congenital heart disease) do not reside within a single plane. For these and other reasons, three-dimensional imaging of the fetal heart ultimately may improve the detection of outflow tract abnormalities, and facilitate comprehension of complex forms of congenital heart disease. Finally, other imaging modalities, including but not limited to Doppler tissue imaging and magnetic resonance imaging, continue to evolve and to complement two- and three-dimensional sonographic imaging of the fetal heart. As a result of these ongoing advances in the prenatal detection and assessment of congenital heart disease, these are exciting and glorious times for the field of fetal cardiac imaging.

Live Three‐Dimensional Echocardiography of the Human Fetus

The purpose of this study was to investigate the feasibility of using a new three-dimensional ultrasound system to perform fetal echocardiographic examination in real time. The device consisted of a Philips Sonos 7500 (Andover, MA) ultrasound system and a 4 MHz, 4X matrix transducer. The study was approved by the Institutional Review Board and was performed with the informed consent of the mother. The study population consisted of 12 singleton fetuses with gestational ages of 16-37 weeks. Of these, ten fetuses had normal cardiac anatomy, one had complete atrioventricular septal defect, and the other a thickened tricuspid valve. The system allowed comprehensive visualization of fetal cardiac anatomy and color Doppler flow unattainable by two-dimensional approaches. This preliminary investigation suggests that live three-dimensional fetal echocardiography could be a significant tool for prenatal diagnosis and assessment of congenital heart disease in the human fetus.

Cardiovascular Shunts: MR Imaging Evaluation

Magnetic resonance (MR) imaging has become an important tool for the accurate and noninvasive assessment of congenital heart disease. Because more precise delineation of anatomy and evaluation of function can be obtained with MR imaging than with either echocardiography or angiography, MR imaging is frequently used to evaluate cardiovascular shunt lesions. It is essential that imaging specialists be able to recognize the MR imaging features of various kinds of shunts, including supracristal ventricular septal defect, atrioventricular septal defect, and partial anomalous pulmonary venous connection. MR imaging is particularly useful for evaluating shunt severity, which can be expressed quantitatively as the ratio of pulmonary flow to systemic flow. This ratio can be estimated accurately with the use of either volumetric cine MR imaging or velocity-encoded cine MR imaging.

Con: Pediatric anesthesiologists should not be the primary echocardiographers for pediatric patients undergoing cardiac surgical procedures

TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) was first introduced in 1976 and appeared in pediatric use in 1989. 1 Frazin L Talano JV Stephanides L et al. Esophageal echocardiography. Circulation. 1976; 54: 102-108 Crossref PubMed Scopus (243) Google Scholar , 2 Ritter S Hillel Z Narang J Transesophageal real-time Doppler flow imaging in congenital heart disease: Experience with a new pediatric transducer probe. Dynamic Cardiovasc Imaging. 1989; 2: 92-96 Google Scholar , 3 Ritter S Thys D Pediatric transesophageal color flow-imaging: Smaller probes for smaller hearts. Echocardiography. 1989; 6: 431-440 Crossref Scopus (42) Google Scholar Although its initial application in the assessment of congenital heart disease (CHD) was limited by probe size, the miniaturization of probes and development of multiplanar imaging greatly increased its role. 4 Stumper OF Elzenga NJ Hess J Sutherland GR Transesophageal echocardiography in children with congenital heart disease: An initial experience. J Am Coll Cardiol. 1990; 16: 433-441 Abstract Full Text PDF PubMed Scopus (93) Google Scholar , 5 Muhiudeen IA Roberson DA Silverman NH et al. Intraoperative echocardiography in infants and children with congenital cardiac shunt lesions: Transesophageal versus epicardial echocardiography. J Am Coll Cardiol. 1990; 16: 1687-1695 Abstract Full Text PDF PubMed Scopus (88) Google Scholar , 6 Lam J Neirotti R Nijveld A et al. Transesophageal echocardiography in pediatric patients: Preliminary results. J Am Soc Echocardiogr. 1991; 4: 43-50 Abstract Full Text PDF PubMed Scopus (27) Google Scholar , 7 Ritter SB Transesophageal echocardiography in children: New peephole to the heart. J Am Coll Cardiol. 1990; 16: 447-450 Abstract Full Text PDF PubMed Scopus (29) Google Scholar , 8 Seward J Khandheria B Freeman W et al. Multiplane transesophageal echocardiography: Image orientation, examination technique, anatomic correlations, and clinical applications. Mayo Clin Proc. 1993; 68: 523-551 Abstract Full Text Full Text PDF PubMed Scopus (192) Google Scholar At present, routine TEE can be safely performed in infants weighing ≥3 kg, and its use has been reported in infants weighing 2.4 kg. 9 Stevenson JG Sorensen GK Gartman DM et al. Transesophageal echocardiography during repair of congenital cardiac defects: Identification of residual problems necessitating reoperation. J Am Soc Echocardiogr. 1993; 6: 356-365 Abstract Full Text PDF PubMed Scopus (100) Google Scholar Excellent image quality and ability to examine the heart without disrupting the surgical field make TEE ideally suited for the intraoperative assessment of cardiac anatomy and physiology during cardiac surgery. This ease of use has led to the replacement of epicardial imaging by TEE.

Feasibility of electron beam tomography in diagnosis of congenital heart disease: comparison with echocardiography

Objective: To evaluate the feasibility of electron beam tomography (EBT) for morphological assessment of congenital heart disease. Materials and methods: Sixteen subjects were examined by EBT, transthoracic echocardiography, cardiac cine angiography and surgery. EBT scan was performed using single slice continuous volume mode to acquire high-resolution static image. Double dose contrast medium was injected by bolus technique after measuring scan delay time and calculation of proper injection rate. The results of EBT and echocardiography were compared based on the results of cardiac cine angiography and surgical findings. All anomalous components were evaluated in all subjects and grouped according to major cardiac structures. Statistical analysis was performed to compare two modalities’ ability to evaluate the anomalies of major structures. Results: EBT was more sensitive to evaluate the anomalies of systemic vessels, pulmonary vessels and small systemic arteries such as coronary artery. EBT was less sensitive to identify the abnormality of cardiac valves such as valvular regurgitation. There was no difference of sensitivity in evaluation of cardiac chambers and septa between the two modalities. Conclusion: EBT assisted by transthoracic echocardiography is excellent noninvasive modality to diagnose congenital heart disease.

Dreidimensionale fetale Echokardiographie - Aktueller Stand und künftige Perspektiven1

The purpose of echocardiographic imaging in the fetus is to provide clear representations of the underlying cardiac anatomy. Studies on pre- and postnatal 3D echocardiography have shown this technique can provide an alternative form of image display for comprehensive assessment of congenital heart disease. To date, several different methods are used for 3D echocardiography in the fetus. The technique used at our institution is analogous to the 3D technology employed in studies on neonates and children and uses an electromagnetic location device to register transducer position during data acquisition. As it derives from a complex assembly of sequentially acquired two-dimensional images this technique has important limitations due to fetal movement artifacts and difficulties in cardiac gating. Despite good three-dimensional appreciation of some anatomical detail, this often results in inadequate image quality when compared with 2D echocardiography. Potential advantages of 3D fetal echocardiography include the following: the ability to slice the acquired 3D volume data into an infinite number of two-dimensional cross-sections, and the ability to reconstruct unique three-dimensional views not seen with two-dimensional imaging. However, considering the limitations and the time needed for 3D image processing its practical clinical relevance in the antenatal situation is still not clear. Ongoing research should be aimed toward improved image resolution and applying this new technique to more immediate "on-line" analysis of 3D reconstructions.

MR imaging of congenital heart diseases in adolescents and adults.

Echocardiography and catheterization angiography suffer certain limitations in the evaluation of congenital heart diseases in adults, though these are overcome by MRI, in which a wide field-of view, unlimited multiplanar imaging capability and three-dimensional contrast-enhanced MR angiography techniques are used. In adults, recently introduced fast imaging techniques provide cardiac MR images of sufficient quality and with less artifacts. Ventricular volume, ejection fraction, and vascular flow measurements, including pressure gradients and pulmonary-to-systemic flow ratio, can be calculated or obtained using fast cine MRI, phase-contrast MR flow-velocity mapping, and semiautomatic analysis software. MRI is superior to echocardiography in diagnosing partial anomalous pulmonary venous connection, unroofed coronary sinus, anomalies of the pulmonary arteries, aorta and systemic veins, complex heart diseases, and postsurgical sequelae. Biventricular function is reliably evaluated with cine MRI after repair of te ralogy of Fallot, and Senning's and Mustard's operations. MRI has an important and growing role in the morphologic and functional assessment of congenital heart diseases in adolescents and adults.