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E2014. Don't Skip a Beat: A Pictorial Review of Congenital Heart Disease in Adults
Authors
  1. Amanda Marrero-Gonzalez; UPR-School of Medicine Diagnostic Radiology Program
  2. Andrea Saldaña Méndez; UPR-School of Medicine Diagnostic Radiology Program
  3. Valerie Vargas Figueroa; UPR-School of Medicine Diagnostic Radiology Program
  4. Andrea Ruiz Mojica; UPR-School of Medicine Diagnostic Radiology Program
  5. José Maldonado Vargas; UPR-School of Medicine Diagnostic Radiology Program
Background
Surgical and medical breakthroughs have made it possible for patients with congenital heart disease to reach adulthood now more than ever before. Currently, the number of adults surpasses the number of children with this condition. In many cases, diagnosis of these conditions has to be reestablished in adulthood, for which understanding cardiac anatomy and disease progression is crucial for the radiologist to describe these complex malformations. Congenital heart diseases may be classified as cyanotic or acyanotic conditions and subclassified based on pulmonary vasculature. The purpose of this educational exhibit is to review the anatomy and classic imaging findings of congenital heart diseases in the adult population to aid in a prompt diagnosis and management, which will positively impact this emergent population’s quality of life.

Educational Goals / Teaching Points
The purpose of this educational exhibit is to review the anatomy of the heart, aortic arch and common anatomical variants, as well as discuss key and characteristic findings of different types of congenital heart disease, including their pathophysiology and basic management. We will also discuss how to recognize classic imaging findings on Chest Radiograph, Computed Tomography and Magnetic Resonance associated with congenital heart disease in adults. We will also evaluate the corresponding surgeries and reinforce the importance of prompt recognition of these diagnoses with their implications in patient morbidity. This educational exhibit is geared towards radiology residents, but will also serve as a review for more experienced radiologists.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Although first-line imaging of patients with congenital heart disease is Echocardiography, evaluation with different imaging modalities including Chest Radiographs, Computed Tomography, and Magnetic Resonance has become almost essential in providing information to determine the next steps concerning management and follow-up of these patients. While Cardiac Magnetic Resonance evaluates morphology and function of the heart, Computed Tomography evaluates cardiac, pulmonary, and vasculature anatomy as well as assessment of biomedical devices such as stents and valves. Chest Radiographs are helpful in comparing heart size and evaluating pulmonary vasculature, lung fields, and the thoracic skeleton. The main goal is to combine all imaging findings in these patients, assess severity, follow them with time to complete a thorough assessment and provide appropriate individualized recommendations to decrease morbidity.

Conclusion
Imaging in adults living with congenital heart disease has become crucial in their lifelong care. With it, patients can be monitored and assessed for performance of invasive procedures, better determining their need for them. It is important for the radiologist to be able to recognize and characterize the imaging features in these conditions to provide appropriate management and follow-up, preventing fatal complications in this population.