E5121. Keep It Pumping: An Analysis of Complex Congenital Heart Disease Imaging
  1. Zainab Ahmad; University of Mississippi Medical Center
  2. Aubrey Smyly; University of Mississippi Medical Center
  3. Johnny Yang; University of Mississippi Medical Center
  4. Zachary Wilson; University of Mississippi Medical Center
  5. William Varner; University of Mississippi Medical Center
  6. Elliot Varney; University of Mississippi Medical Center
  7. Candace Howard; University of Mississippi Medical Center
Congenital heart disease affects roughly 1% of all newborn infants. In complex cases, the prognosis is poor without intervention. However, most of these patients are now able to survive into adulthood thanks to advances made within the field of cardiology and cardiac surgery. Patients often require lifelong follow up to improve lifetime morbidity and mortality. Transthoracic ECG (TTE) is the current first-line, low-cost modality which allows real-time visualization of the heart. However, issues with tissue penetration and limited FOV can limit its utility in complex disease. Cardiac MRI (cMRI) is a versatile imaging modality, which can be used to assess congenital heart defects in patients of all ages without the use of ionizing radiation. Additionally, CTA aids in the evaluation of associated vascular anomalies and/or abnormalities in the lung parenchyma. Cross-sectional imaging allows for an increased FOV and improved spatial and temporal resolution compared to TTE. There is a need to educate trainees and general radiologists of the imaging features of pre and postoperative evaluations in congenital heart disease, as these are rare abnormalities with complex imaging findings, which allow the radiologist to play a crucial role in patient follow up and management, given the increasing number of patients with prolonged survival.

Educational Goals / Teaching Points
We will review the advantages and disadvantages of cardiac TTE, cMRI, and cardiac CTA imaging in patients with complex congenital heart disease. Imaging strategies and protocols will be discussed as related to congenital heart disease. We will present cases demonstrating characteristic findings within a variety of cardiac defects including, but not limited to, left ventricular hypoplasia, tetralogy of Fallot, and anomalous pulmonary venous return.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Because imaging findings are often subtle, each case will be annotated to show all anomalies associated with the case and postsurgical changes. Clinical indications and image findings will be outlined for each case, along with the correlated imaging protocols, and, if pertinent, reasons why further imaging could be suggested. Additional information regarding imaging techniques, acquisition details, and protocol will be given when appropriate.

A multimodality approach has proven useful in the evaluation of patients with congenital heart disease, as each modality has its own benefits and limitations. A systematic approach to the anatomic features of each pathology, as well as familiarity with the postsurgical findings and complications, are essential in the evaluation of complex congenital heart disease, as findings are often subtle and can cause confusion for the diagnostician.