Illustrated Imaging Essay on Congenital Heart Diseases: Multimodality Approach Part I: Clinical Perspective, Anatomy and Imaging Techniques

Abstract

Rapid evolution in technology in the recent years has lead to availability of multiple options for cardiac imaging. Availability of multiple options of varying capability, poses a challenge for optimal imaging choice. While new imaging choices are added, some of the established methods find their role re-defined. State of the art imaging practices are limited to few specialist cardiac centres, depriving many radiologists and radiologist in-training of optimal exposure to the field. This presentation is aimed at providing a broad idea about complexity of clinical problem, imaging options and a large library of images of congenital heart disease. Some emphasis is made as to the need of proper balance between performing examination with technical excellence in an ideal situation against the need of the majority of patients who are investigated with less optimal resources. Cases of congenital cardiac disease are presented in an illustrative way, showing imaging appearances in multiple modalities, highlighting specific observations in given instance.

Keywords: Cardiac anomalies; Cardiac imaging; Cardiac imaging anatomy; MDCT; MRI.

[Table/Fig-5a, 5b]:

a) Diagrammatic representation of location of cardiac chambers in relation to cardiac silhouette on a plain chest radiography; b) Diagrammatic representation of normal anatomical landmarks in right atrium, right ventricle and left ventricle. Landmarks highlighted are Crista terminalis, fossa ovalis, ostium of coronary sinus, Eustachian valve.

[Table/Fig-6a-f]:

Echocardiography imaging planes (a) Parasternal long axis view of the ventricles (b,d) 4 -chamber views of the heart from sub-costal and apical approach. (c) Subcostal short axis view at mid ventricles (e) Parasternal short axis view at the level of aortic root/pulmonary artery. (f) Supra-sternal view illustrates anatomy of the aortic arch and its branch.

[Table/Fig-8]:

a) Coronal CT image shows SVC (arrow), tricuspid valve (open arrow) and RA cavity; b) Lateral CT images shows SVC and ICV draining in to RA; c) Coronal image slightly anteriorly shows atrial appendage (arrow) Crista supra-ventricularis is located between TV and pulmonary artery.

[Table/Fig-9]:

d) Coronal CT demonstrating trabeculated right ventricular cavity and moderator band (arrow); e) Modified long axial vies of LV shows papillary muscles (triangles), cordae tendinae(arrow), mitral valve and LV cavity; f) CT 3 chamber view shows mitral (arrow), aortic valve (triangles), mitral-aortic continuity and LV outflow.

[Table/Fig-10]:

g) Axial CT view shows aortic value (arrows) and LA cavity. Both inferior pulmonary veins are seen entering postero-laterally (triangles); h) Coronal CT images demonstrates entry of superior and inferior pulmonary veins (asterix); i) Modified coronal CT images showing left atrial appendage (arrow).

[Table/Fig-11a,b]:

:(a,b) Black and bright bold 4-chamber MR images showing cardiac chambers.

[Table/Fig-12]:

Standard imaging planes in CMR: LV and 4-ch view.

[Table/Fig-13]:

Standard imaging planes in CMR: Short axis and 3-CH view.

[Table/Fig-14]:

Standard imaging planes in CMR: 3-CH and LVOT view.

[Table/Fig-15]:

Standard imaging planes in CMR: RVOT and aortic view.