Advances in Pediatric Cardiovascular Imaging

Abstract

Cardiac imaging plays a key role in the accurate diagnosis of pediatric congenital heart disease (CHD). Echocardiography and catheter angiography are traditionally used to delineate cardiac anatomy. CT and MRI imaging offer a non-invasive way to image cardiovascular anatomy which can be used in conjunction with echocardiography for the diagnosis and treatment planning for CHD. These modalities can depict the morphology and relationship to surrounding structures better than echocardiography, especially in complex congenital defects.

Figure 1

Three dimensional echocardiogram images show excellent resolution of an open (A) and closed (B) aortic valve.

Figure 2

(A) Sagittal oblique CT images of a 15 month old for arch evaluation. Mild hypoplasia of the distal transverse arch and narrowing of the juxtaductal arch consistent with coarctation. Patient also had a patent ductus arteriosus. (B) 3 dimensional images show area of arch narrowing and relation to the patient’s PDA.

Figure 3

Axial (A) and sagittal (B) CT angiography demonstrates a right sided aortic arch with posterior compression on the trachea. (C) 3D reformatted image shows the relationship of the trachea and right sided aortic arch.

Figure 4

(A) Axial image from a gated cardiac CT shows an anomalous right coronary artery arising off the left aorta and coursing intra-arterial between the aorta and main pulmonary artery. (B and C) Multiplanar reconstructed images show the takeoff of the RCA is superior to the commissure between the right and left coronary cusps. The RCA origin is ovoid and has an acute angled take off

Figure 5

Examples of Cardiac MRI with use of Ferumoxytol as a contrast agent. (A) Shows a slightly posterior [benign variant] origin of the left coronary origin in detail on contrast MRI. (B) Excellent contrast enhancement of the ascending aorta which can be used for evaluation of vessel size and anatomy.

Figure 6

8-year-old with hypertrophic cardiomyopathy. MRI images in short axis (A) shows asymmetric thickening of the septal wall with patchy mid-septal delayed post contrast enhancement (B and C) consistent with fibrosis [red arrows].