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Imaging in Congenital Heart Disease

Professor Owen Miller, EACVI Board member, Consultant in Paediatric and Fetal Cardiology, Evelina London Children’s Hospital, UK

“The first investigation in children with suspected CHD is always imaging; you need to clarify the underlying anatomy and cardiac connections, assess whether there are normal chambers and valves present and so on. Even before birth, fetal echocardiography is now standard and more recently, fetal cardiac MRI is being used to look at structures in the fetal heart. After birth, if the clinical exam suggests a heart problem, echocardiography is the primary modality for a comprehensive examination of the heart of a newborn. Some children have very complex abnormalities and more investigation is needed; multimodality investigations to understand the 3-dimensional structure of the heart and vessels include MRI and CT, often all three combined in particularly complex lesions. Once a child is diagnosed with CHD, cardiac surgery might be needed. Pre-operative, intra-operative and post-operative echocardiography is now standard of care, often without any need for angiography, thus sparing the child from further radiation exposure. Finally, post-operative follow-up of CHD patients – spanning over decades – also requires a repeatable and low-risk modality where echocardiography again proves to be ideal. This is of particular importance in the growing child where surgery which may have been performed as a newborn might be repeated in subsequent years. Adults with CHD (ACHD) need specific care in terms of on-going progress assessments and monitoring where echocardiography will continue to play a role as well a higher demand for CT and MRI. Assessing heart function again becomes more important as the diagnosis is already known. Now that paediatric cardiology is firmly established and growing, we as pediatric cardiologists would like to be more involved in the development of new technology. A dialogue on CHD between clinicians and industry is what we are looking for.”