What is new in pediatric cardiac imaging?

Abstract

Cardiac imaging has had significant influence on the science and practice of pediatric cardiology. Especially the development and improvements made in non-invasive imaging techniques, like echocardiography and cardiac magnetic resonance imaging (MRI), have been extremely important. Technical advancements in the field of medical imaging are quickly being made. This review will focus on some of the important evolutions in pediatric cardiac imaging. Techniques such as intracardiac echocardiography, 3D echocardiography, and tissue Doppler imaging are relatively new echocardiographic techniques, which further optimize the anatomical and functional aspects of congenital heart disease. Also, the current standing of cardiac MRI and cardiac computerized tomography will be discussed. Finally, the recent European efforts to organize training and accreditation in pediatric echocardiography are highlighted.

Fig. 1

Intracardiac echoprobes of 10 F and 8 F

Fig. 2

Three-dimensional images. a 3D view from the left atrium on an abnormal mitral valve. b Shows how the volume and ejection fraction can be calculated based on a 3D dataset. After border detection a 3D volume of the left ventricle is calculated and represented by the ‘mesh’. This can be done throughout the cardiac cycle allowing calculation of end systolic and end diastolic left ventricular volumes. When these volumes are known, ejection fraction can be calculated

Fig. 3

Tissue Doppler velocities can be measured in different segments of the left and right ventricle. In this figure longitudinal velocities in the basal, mid, and apical segments of the interventricular septum and the left ventricular lateral wall are depicted. In the traces obtained, we can measure a peak systolic velocity as well as an early and late diastolic velocity. The systolic and diastolic velocities vary in different myocardial segments with a velocity gradient going from base to apex. The lowest velocities are measured at the apex which is relatively immobile

Fig. 4

Principle of strain measurements. Based on the velocity gradient from base to apex (in the longitudinal direction) or from endocardium to epicardium (in the radial direction), strain rate can be calculated. Integrating the strain rate curve in time results in a strain curve. Strain measures the percentage deformation in a segment, and strain rate measure the rate of deformation in a segment

Fig. 5

This figures illustrates strain and strain rate curves obtained in the posterior wall. From these curves, peak systolic strain rate and end-systolic strain values are obtained which are used as parameters for regional cardiac function. When deformation is reduced this indicates a regional reduced cardiac performance

Fig. 6

Isovolumetric acceleration. During the isovolumetric contraction period, there is a velocity spike in the tracing. The acceleration of this velocity spike is a good parameter for intrinsic contractility