Evaluation of adult congenital heart disease by cardiac magnetic resonance imaging

Abstract

Cardiovascular magnetic resonance (CMR) imaging plays an essential role in the evaluation and follow-up of adult congenital heart disease (ACHD), providing safe, high-resolution imaging of some of the most complex anatomies encountered. Unlimited by acoustic windows and capable of tissue characterization, CMR is devoid of ionizing radiation and provides superior three-dimensional spatial resolution to transthoracic echocardiography and superior temporal resolution to computed tomography, making it the gold standard for various cardiac and great vessel imaging indications in ACHD. In this state-of-the art review, we provide an overview of CMR examination methods and detail the various approaches and classical findings in the more common forms of ACHD. Although this review touches upon technical aspects of CMR imaging in ACHD, it is primarily geared toward the adult congenital caregiver (i.e., clinical, interventional, or surgical), highlighting relevant practical considerations. To enhance the clinical utility of this review, numerous examples with intraoperative correlates are provided to highlight our imaging approaches for various defects. As CMR image acquisition may be time consuming and requires patient collaboration (e.g., intermittent breath holding), a systemic approach is required to maximize efficiency. A thorough knowledge of ACHD anatomy and natural history is essential in maximizing image interpretation. Proficient scanning is further enabled by clearly outlined study objectives with prior documentation of interventional and surgical procedures, where applicable.