Evidence-Based Approach to Imaging of Congenital Heart Disease


Key Points

■ Chest radiographs do not function as a screening test for suspected CHD in neonates. If CHD cannot be excluded by clinical examination, echo is the preferred modality (moderate evidence).

■ In patients with CHD, chest radiography has low accuracy for diagnosis of specific cardiac lesions (moderate evidence) but provides ancillary information regarding pulmonary vascularity which is helpful in initial management.

■ Routine daily chest radiographs are useful in the setting of pediatric and neonatal intensive care units and in the immediate post-operative period after repair of CHD (moderate evidence).

■ MRI should be considered the gold standard for evaluation of RV size and function in the setting of CHD (strong evidence). Two-dimensional echo measurements of RV size and mass correlate poorly with MRI parameters (moderate evidence). Three- and four-dimensional echo hold promise for measurement of RV volume and mass in the setting of CHD, but further study is required (limited evidence).

■ MRI parameters (RV end-diastolic volume, RV end-systolic volume, and biventricular ejection fraction) and EKG parameters (QRS duration on the resting EKG of >180 msec) are the best predictors of adverse clinical outcome in patients with treated tetralogy of Fallot (moderate evidence). The optimal timing of pulmonary valve replacement for patients with corrected TOF is undetermined but is influenced by MRI parameters of RV size and function (indexed RV volume and RV ejection fraction).

■ MRI can replace cardiac catheterization for routine evaluation of cardiovascular morphology and function prior to superior cavopulmonary connection in the majority of patients undergoing single-ventricle repair (moderate evidence).

■ The role of multidetector CT is mainly as a problem-solving tool when MRI is contraindicated, limited, or not available (limited evidence). MDCT is accurate for diagnosing coronary artery anomalies, coarctation, and post-operative complications, but concerns regarding high radiation exposure has limited its use.


Right Ventricular Congenital Heart Disease Right Ventricular Outflow Tract Right Ventricular Ejection Fraction Pulmonary Valve Replacement 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.EB Singleton Department of Diagnostic ImagingTexas Children’s Hospital, Baylor College of MedicineHoustonUSA
  2. 2.Department of Internal MedicineBaylor College of MedicineHoustonUSA

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