CT and MRI in Congenital Heart Diseases

Foreword
Preface
Contents
About the Editors and Contributors
About the Editors
Contributors
Part I: The Basics of CHD imaging
1: CMR Physics
1.1 Introduction
1.2 Hardware
1.2.1 Magnets
1.2.2 Coils
1.3 Principle
1.4 MR Signal Formation
1.4.1 Radio-frequency Excitation
1.4.2 180° and 90° Pulse
1.4.3 T1 Relaxation/Spin: Lattice Relaxation
1.4.4 T2 Decay or Spin: Spin Relaxation
1.4.5 T2* Relaxation
1.5 MR Signal Localization
1.5.1 Slice Selection
1.5.2 Phase Encoding
1.5.3 Frequency Encoding
1.5.4 k-Space
1.5.5 Scan Time
1.6 Sequences
1.6.1 Spin-Echo (SE) Imaging
1.6.2 Gradient-Echo (GRE) Imaging
1.6.3 Parallel Imaging
1.6.4 Myocardial Tagging
1.6.5 Contrast-Enhanced (CE) Imaging
1.6.6 Mapping Sequences
1.7 ECG Gating
1.8 MR Artifacts
1.8.1 Equipment-Related Artifacts
1.8.2 Aliasing or Wrap-Around Artifact
1.8.3 Aliasing During Flow Analysis
1.8.4 Chemical Shift Artifact
1.8.5 Truncation or Gibbs Artifact or Dark Rim Artifact
1.8.6 Magnetic Susceptibility Artifact
1.8.7 Trigger Artifact
1.8.8 Blood Flow Artifact
1.9 Conclusion
References
2: Cardiac Embryology
2.1 Introduction
2.2 Early Embryonic Development
2.3 Cardiac Development
2.3.1 Formation of the Endocardial Tube
2.3.1.1 Clinical Correlate
2.4 Determination of Right-Left Symmetry
2.4.1 Clinical Correlate
2.5 Formation of the Myocardium
2.5.1 Clinical Correlate
2.6 Formation of the Four-Chambered Heart
2.7 Formation of the Right and Left Atrioventricular Canals
2.7.1 Clinical Correlate
2.8 Formation of the Interventricular Septum (IVS)
2.8.1 Clinical Correlate
2.9 Formation of the Interatrial Septum
2.9.1 Clinical Correlates
2.10 Separation of the Outflow Tracts
2.10.1 Clinical Correlate
2.10.1.1 Conotruncal Anomalies
2.10.1.2 Truncus Arteriosus
2.10.1.3 D: Transposition of the Great Arteries
2.10.1.4 Tetralogy of Fallot (TOF)
2.10.1.5 Double Outlet Right Ventricle (DORV)
2.11 Development of the Aortic Arches and the Great Vessels
2.11.1 Clinical Correlate
2.11.1.1 Double Aortic Arch
2.11.1.2 Right Aortic Arch
2.11.1.3 Aberrant Right Subclavian Artery
2.11.1.4 Interruption of the Aortic Arch
2.11.1.5 Patent Ductus Arteriosus (PDA)
2.11.1.6 Coarctation of the Aorta
2.12 Formation of the Venous System
2.12.1 Clinical Correlate
2.12.1.1 Persistent Left Superior Vena Cava
2.12.1.2 Isolated Left Superior Vena Cava
2.12.1.3 Azygous Continuation of the Inferior Vena Cava
2.12.1.4 Double Interior Vena Cavae
2.13 Fetal Circulation
References
3: Cross-Sectional Imaging Atlas
4: Technical Aspects of Pediatric Cardiac CT
4.1 Introduction
4.2 Common Indications for Pediatric CCT
4.3 Technical Requirements for Pediatric Cardiac CT
4.4 Technical Parameters for a Successful Cardiac CT
4.4.1 Intravenous (IV) Access
4.4.2 Sedation
4.4.3 Fasting
4.4.4 Contrast Media
4.4.5 CT Angiography Procedure
4.4.6 Timing of CTA Scan
4.4.7 Scan Range
4.4.8 Single-Phase Versus Multiphase CT Angio
4.4.9 ECG-Gated Versus Non-ECG Gated Study
4.4.9.1 Non-ECG Gated Scan
4.4.9.2 Retrospective ECG-Gated Spiral Scan
4.4.9.3 Prospective ECG-Gated Sequential Scan
4.4.9.4 Prospectively ECG-Triggered High-Pitch Helical CT
4.5 Processing the Raw Data
4.6 Image Reconstruction
4.7 Keep Radiation to Minimum (ALARA)
4.8 Documentation and Storage of Data
4.9 3D Printing
References
5: Scan Techniques for Pediatric Cardiac MRI
5.1 Introduction
5.2 Paediatric CMR Set-Up
5.3 Sedation/Anaesthesia
5.4 Patient Positioning and Coil Placement
5.5 ECG Placement
5.6 Breath-Holding Versus Free-Breathing Scan
5.7 MRI Scanner
5.8 Contrast Media for MRI
5.9 MRI Acquisition Protocol
5.10 CMR Pulse Sequences
5.10.1 Black Blood Sequences
5.10.2 Bright Blood Cine Imaging
5.10.3 MR Angiography
5.10.3.1 Contrast MRA
Technique
Contrast Timing
5.10.3.2 Non-contrast MRA
5.10.4 Phase-Contrast Velocity Mapping Imaging
5.10.5 Myocardial Viability Imaging
5.11 MRI Imaging Planes
5.12 Standard CMR Pulse Sequences for CHD
5.13 Postprocessing
5.14 MR Imaging Safety
References
6: Sequential Segmental Approach to CHD
6.1 Introduction
6.2 Basic Concepts of Sequential and Segmental Approach
6.3 Morphologic Features of Different Cardiac Chambers
6.3.1 Atria
6.3.2 Ventricles
6.3.3 Great Arteries
6.4 Anatomical Analysis of Each Segment
6.5 Conclusion
References
Part II: Imaging in Congenital Heart Disease
7: Congenital Aortic Anomalies
7.1 Introduction
7.2 Normal Embryology
7.3 Imaging Protocols
7.3.1 CT Aortogram
7.3.2 MR Angiogram
7.4 Aortic Root Anomalies
7.4.1 Truncus Arteriosus
7.4.2 Aorto-Pulmonary Window (AP Window: APW)
7.4.3 Transposition of Great Arteries (TGA)
7.4.4 Sinus of Valsalva Aneurysm
7.4.5 Supravalvar Aortic Stenosis
7.4.6 Aorta to LV Fistula
7.4.7 Aortic Valve Anomalies
7.4.8 Ascending Aortic Atresia
7.5 Aortic Arch Anomalies
7.5.1 Hypoplastic Aortic Arch
7.5.2 Coarctation of Aorta
7.5.3 Interrupted Aortic Arch
7.5.4 Congenital Ductus Arteriosus Aneurysm
7.6 Genetic Anomalies Affecting the Aorta
7.6.1 Marfan Syndrome
7.6.2 Arterial Tortuosity Syndrome (ATS)
References
8: Vascular Rings and Slings
8.1 Introduction
8.2 Embryology
8.3 Types of Vascular Rings and Slings
8.3.1 Double Aortic Arch
8.3.1.1 Double Aortic Arch with Both Arches Patent
8.3.1.2 Double Aortic Arch with Atresia or Hypoplasia of One Arch with Fibrous Remnant
8.3.2 Left Aortic Arch with Aberrant Right Subclavian Artery and Kommerrell’s Diverticulum
8.3.3 Right Aortic Arch with Aberrant Left Subclavian Artery and Kommerrell’s Diverticulum
8.3.4 Right Circumflex Aorta and Left Circumflex Aorta
8.3.5 Left Aortic Arch with Aberrant Course of Right Subclavian Artery
8.3.6 Right Aortic Arch with Aberrant Course of Left Subclavian Artery Without Retroesophageal Diverticulum
8.3.7 Right Aortic Arch with Mirror-Image Branching
8.3.8 Innominate Artery Compression Syndrome
8.3.9 Pulmonary Sling
8.4 Conclusion
References
9: Radiological Review of Coronary Artery Anomalies
9.1 Introduction
9.2 Normal Anatomy of the Coronary Arteries
9.2.1 Coronary Artery Dominance
9.2.2 Right Coronary Artery (RCA)
9.2.3 Left Main Coronary Artery (LMCA)
9.2.4 Left Anterior Descending Artery (LAD)
9.2.5 Left Circumflex Artery (LCx)
9.2.6 Ramus Intermedius (RI)/(Medianus)
9.3 Normal Variants
9.3.1 Right Superior Septal Perforator
9.3.2 Supernumerary Coronary Ostia
9.3.3 Myocardial Bridging
9.4 Coronary Anomalies
9.5 Hemodynamically Significant Anomalies
9.5.1 Coronary Ostial Stenosis or Atresia (COSA)
9.5.2 Anomalous Origin of the Coronary Artery from a Ventricle
9.5.3 Anomalous Origin of the Coronary Artery from the Pulmonary Artery
9.5.4 Inter-arterial/Malignant course
9.5.5 Coronary Arterial Fistula
9.5.6 Aorto-Atrial Tunnel
9.6 Hemodynamically Less Significant Anomalies
9.6.1 Duplication
9.6.2 High Origin/High “Takeoff”
9.6.3 Single Coronary Artery (SCA)
9.6.4 Pre-pulmonic Course
9.6.5 Trans-Septal Course
9.6.6 Retro-Aortic Course
9.6.7 Acute Takeoff of LCx
9.6.8 Shepherd’s Crook RCA
9.6.9 Coronary Arcade
9.6.10 Extracardiac Termination
9.7 Conclusion
References
10: Imaging in Pulmonary Atresia with Ventricular Septal Defect
10.1 Introduction
10.2 Etiology
10.3 Embryology
10.4 Morphology
10.5 Classification
10.6 Pathophysiology
10.7 Clinical Presentation
10.8 Imaging Modalities
10.8.1 Chest X-Ray
10.8.2 Echocardiography
10.8.3 Cardiac Catheterization
10.8.4 MR Angiography (MRA)
10.8.4.1 Assessment of Morphology
10.8.4.2 Functional Assessment
10.8.5 CT Angiography (CTA)
10.8.5.1 Technical Factors
10.8.5.2 Image Post-processing
10.9 MDCT and MRI Evaluation of PA-VSD
10.9.1 Pulmonary Arteries
10.9.2 PDA
10.9.3 MAPCAs
10.9.4 Z-Score
10.9.5 McGoon’s Ratio
10.9.6 Nakata Index
10.9.7 Total Neo-pulmonary Artery Index (TNPAI)
10.9.8 Lung Arborization (Distribution)
10.9.9 Aortic Anomalies
10.9.10 Coronary and Intracardiac Abnormalities
10.9.11 Septal Defects
10.9.12 Intracardiac Morphology
10.9.13 Pulmonary and Systemic Venous System
10.9.14 Situs Anomalies
10.10 Management
10.10.1 Single-Stage Versus Multi-Stage Approach
10.10.1.1 Single-Stage Approach
10.10.1.2 Multi-Stage Approach
10.10.1.3 Comparison Between Multi- and Single-Stage Repair
10.11 Postoperative Assessment Using MDCT and MRI
10.11.1 Aortopulmonary Shunts
10.11.2 Classic Cavopulmonary Shunt (Glenn Operation)
10.11.3 The Bidirectional Glenn Shunt
10.11.4 Fontan Procedure
10.12 Limitations of MDCT
References
11: Congenital Pulmonary Venous Anomalies
11.1 Introduction
11.2 Embryology of the Pulmonary Veins
11.3 Normal Pulmonary Venous Anatomy
11.4 Normal Variant Pulmonary Venous Drainage
11.5 Imaging Modalities
11.5.1 Chest Radiography
11.5.2 Echocardiography
11.5.3 CT Scan
11.5.4 MRI
11.6 Congenital Pulmonary Vein Anomalies
11.6.1 Total Anomalous Pulmonary Venous Drainage (TAPVD)
11.6.1.1 Imaging of TAPVD: Chest Radiography
11.6.2 Partial Anomalous Pulmonary Venous Drainage (PAPVD)
11.6.2.1 Imaging of PAPVD: Chest Radiography
11.6.2.2 CT/MRA
11.6.3 Sinus Venosus Defect
11.6.4 Congenital Pulmonary Venolobar Syndrome
11.6.4.1 Scimitar Syndrome
11.6.4.2 Pulmonary Sequestrations and Variants
11.6.4.3 Horseshoe Lung
11.7 Malposition of the Septum Primum
11.8 Meandering Pulmonary Vein
11.9 Levoatriocardinal Vein
11.10 Cor Triatriatum
11.11 Pulmonary Vein Stenosis/Hypoplasia/Atresia
11.12 Pulmonary Vein Varix
11.13 Pulmonary Arteriovenous Malformation
11.14 Post-operative TAPVD
11.15 Summary
References
12: CT and MRI of Simple Cardiovascular Shunts
12.1 Introduction
12.2 Atrial Septal Defect (ASD)
12.2.1 Introduction
12.2.2 Normal Anatomy of Inter-Atrial Septum (Fig. 12.2)
12.2.3 Classification of ASD (Fig. 12.3)
12.2.4 Ostium Secundum ASD (Fig. 12.4)
12.2.5 Ostium Primum ASD (Fig. 12.5)
12.2.6 Sinus Venosus ASD (Figs. 12.6 and 12.7)
12.2.7 Unroofed Coronary Sinus (Fig. 12.8)
12.2.8 Common Atrium
12.2.9 Patent Foramen Ovale (PFO) (Figs. 12.9 and 12.10)
12.2.10 Clinical Features
12.2.11 Imaging Findings
12.2.12 Treatment
12.3 Ventricular Septal Defect (VSD)
12.3.1 Introduction
12.3.2 Embryology (Figs. 12.11 and 12.12)
12.3.3 Normal Anatomy of Interventricular Septum (Figs. 12.13, 12.14, and 12.15)
12.3.4 Pathophysiology of VSD
12.3.5 Complications of VSD
12.3.6 Classification
12.3.7 Imaging Findings
12.3.7.1 Central Perimembranous VSD (Figs. 12.16 and 12.17)
12.3.7.2 Muscular: Trabecular VSD (Figs. 12.18 and 12.19)
12.3.7.3 Inlet VSD (Fig. 12.20)
12.3.7.4 Outlet VSD (Fig. 12.21)
12.3.8 Clinical Presentation
12.3.9 Treatment
12.4 Atrio-Ventricular Septal Defect (AVSD)
12.4.1 Introduction
12.4.2 Classification [15] (Table 12.3)
12.4.3 Associations
12.4.4 Pathophysiology
12.4.5 Clinical Presentation
12.4.6 Imaging Findings (Fig. 12.22)
12.4.7 Treatment
12.5 Patent Ductus Arteriosus (PDA)
12.5.1 Introduction
12.5.2 Embryology
12.5.3 Morphology
12.5.4 Pathophysiology
12.5.5 Clinical Features
12.5.6 Imaging Findings
12.5.7 Treatment
12.6 MRI Quantification of Shunts [26, 27]
12.6.1 Calculating Shunt Across Atrial Septal Defect (Fig. 12.30)
12.6.2 Calculating Shunt Across Ventricular Septal Defect (Fig. 12.31)
12.6.3 Calculating Shunt Across Patent Ductus Arteriosus (Fig. 12.32)
12.6.4 Illustrative Examples
References
13: Ebstein Anomaly
13.1 Introduction
13.2 Epidemiology and Risk Factors
13.3 Embryology
13.4 Pathological Anatomy
13.5 Associated Abnormalities
13.6 Pathophysiology
13.7 Classifications
13.8 Clinical Presentation
13.9 Approach to Diagnosis and Evaluation
13.10 Imaging Tests
13.10.1 Chest Radiograph (CXR)
13.10.2 Echocardiography
13.10.2.1 Transesophageal Echocardiogram (TEE)
13.10.3 CT
13.10.3.1 Indications for CT
13.10.4 CMR
13.10.5 CMR Protocol
13.10.6 Preoperative CMR Imaging Checklist
13.10.7 Postoperative CMR Imaging Checklist
13.11 Treatment
13.11.1 Prenatal
13.11.2 Neonates
13.11.3 Children, Adolescents, and Adults
13.12 Ebsteinoid Malformation of Left AV Valve in L-TGA
13.13 Differential Diagnosis
References
14: Pre- and Postoperative Imaging in Tetralogy of Fallot
14.1 Definition
14.2 Introduction
14.3 Pathophysiology
14.4 Management of TOF
14.4.1 Single-Stage Repair
14.4.2 Multi-stage Repair
14.4.3 Natural History Post Surgery
14.5 Imaging Techniques
14.5.1 Chest Radiograph
14.5.2 Echocardiography
14.5.3 Cardiac Catheterization
14.5.4 Computed Tomography Angiography (CTA)
14.5.5 Cardiac MR (CMR)
14.6 Preoperative Imaging of TOF
14.6.1 Characterization of Primary Lesion
14.6.1.1 Right Ventricle Outflow Tract Obstruction (RVOTO)
14.6.1.2 Ventricular Septal Defect
14.6.2 Pulmonary Arteries
14.6.2.1 Aortic Anatomy
14.6.2.2 Coronary Anatomy
14.6.2.3 Atrial Septal Defects
14.6.2.4 Pulmonary Venous Return
14.6.2.5 Airway Compression
14.7 Postoperative Imaging in TOF
14.7.1 Imaging Post BT Shunt
14.7.2 Imaging Post Intracardiac Repair (ICR)
14.8 Conclusion
References
15: Double Outlet Right Ventricle: Morphology and Function
15.1 Introduction
15.2 History
15.3 Embryology
15.4 Pathophysiology
15.5 CT and MR Imaging Techniques
15.5.1 MSCT
15.5.2 MRI Techniques
15.6 Morphology of DORV
15.7 Common Variants of DORV (Summarized in Table 15.1)
15.7.1 Tetralogy of Fallot (TOF)-Like Variant (Figs. 15.5, 15.6, and 15.7)
15.7.2 Transposition of Great Arteries (TGA)-Like Variant (Taussig–Bing Anomaly) (Figs. 15.8, 15.9, 15.10, 15.11, and 15.12)
15.7.3 Variant Resembling VSD (Fig. 15.13)
15.7.4 Variant Resembling a Univentricular Heart (Figs. 15.14, 15.15, and 15.16)
15.8 Less Frequent Variants of DORV
15.8.1 DORV with Subaortic VSD, Aorta Left to Pulmonary Trunk with PS (Figs. 15.17 and 15.18)
15.8.2 DORV with Noncommitted VSD (Fig. 15.19)
15.8.3 DORV with Discordant Atrioventricular Connection (Figs. 15.20 and 15.21)
15.8.4 DORV with Mirror-Image Atrial Arrangement (Fig. 15.22)
15.8.5 DORV with Isomeric Atrial Appendages (Ambiguous AV Connection)
15.8.6 DORV Without VSD
15.9 Associated Other Cardiac Anomalies
15.9.1 Juxtaposition of the Atrial Appendages (Fig. 15.28)
15.9.2 Abnormalities of the Atrioventricular Valves
15.10 3D Printing in DORV
15.11 Surgical Repair [29–33]
15.11.1 LV to Aorta Routability
15.11.2 Postoperative Complications
15.12 Double Outlet Left Ventricle (DOLV)
15.13 Conclusion
References
16: Pre- and Postoperative Imaging in Transposition of Great Arteries
16.1 Introduction
16.2 Embryology
16.3 Morphology
16.3.1 Coronary Arteries in TGA [5, 6]
16.4 Differential Diagnosis
16.5 Pathophysiology
16.6 Clinical Aspects
16.7 Management of TGA
16.7.1 Surgical Options
16.8 Expected Complications of Surgery
16.9 Imaging in TGA
16.10 Postoperative evaluation [15]
16.10.1 Senning and Mustard Repair
16.10.2 Arterial Switch Operation
16.10.3 Rastelli Operation
16.10.4 Double Switch Surgery
16.10.5 Nikaidoh Procedure
16.11 Comparison Between Cardiac CT Versus Cardiac MRI
References
17: Imaging of Single Ventricle
17.1 Introduction
17.2 Evolution of Concept of Single Ventricle
17.3 Classification
17.3.1 True Univentricular Heart
17.3.2 Functionally Univentricular Heart
17.4 Physiology of Univentricular Hearts
17.5 Pattern/Arrangement of Univentricular Heart
17.5.1 Univentricular Hearts That Are Morphological LV
17.5.2 Univentricular Heart with Morphological Right Ventricle
17.6 Epidemiology and Natural History
17.7 Fontan Circulation
17.8 Imaging of the Single Ventricle
17.8.1 ECG
17.8.2 X-Ray
17.8.3 Echocardigraphy (Figs. 17.9, 17.10, 17.11, and 17.12)
17.8.3.1 Approach
17.8.3.2 AV Valve
17.8.3.3 Great Arteries
17.8.4 Cardiac MRI (Figs. 17.13, 17.14, 17.15, and 17.16)
17.8.5 Cardiac CT (Figs. 17.16, 17.17, 17.18, 17.19, and 17.20)
17.8.5.1 Scanning Protocol
17.8.5.2 Image Analysis
17.8.6 Cardiac Catheterisation
17.9 Common Conditions Producing Univentricular Heart
17.9.1 Tricuspid Atresia
17.9.2 Double Inlet Left Ventricle (DILV)
17.9.3 Hypoplastic Left Heart Syndrome
17.10 Conclusion
References
18: CT and MR Imaging in Post-operative CHD
18.1 Introduction
18.2 Suggested Imaging Protocol
18.2.1 CMR Protocol
18.2.2 CTA Protocol
18.3 Common Surgical Procedures Used for Palliation and Correction of CHDs and Their Imaging Findings
18.4 Palliative Procedures
18.4.1 Other Palliative Procedures
18.5 Corrective Surgeries for Common CHDs
18.5.1 Tetralogy of Fallot (TOF)
18.5.2 Transposition of Great Arteries (TGA)
18.5.3 Double Outlet Right Ventricle (DORV)
18.5.4 Coarctation of Aorta
18.6 Imaging of Complications of Palliative Shunts
18.7 Imaging of Complications of Repaired CHDs
18.7.1 Tetralogy of Fallot (TOF) and TOF-Type Double Outlet Right Ventricle (DORV)
18.7.2 Transposition of Great Arteries (TGA) and TGA-Type Double Outlet Right Ventricle (DORV)
18.7.3 Coarctation of Aorta
18.8 Conclusion
References
19: Valvular Heart Disease
19.1 Introduction
19.1.1 MRI Assessment of Valve Morphology
19.1.2 Flow Mechanics and Valve Mathematics
19.1.2.1 Normal Flow Patterns
19.1.2.2 Abnormal Flow Patterns
19.1.3 MRI Techniques to Evaluate Valvular Function
19.1.3.1 Qualitative Assessment of Valve Function
19.1.3.2 Quantitative Assessment of Valve Function
Potential Pitfalls of Flow Quantification Using Phase-Contrast Imaging
Interpretation of Phase-Contrast Flow Maps
19.2 Merits and Limitations of Echocardiography and CMR
19.3 Role of CT in the Assessment of VHD
19.4 Aortic Valve
19.4.1 Aortic Stenosis
19.4.1.1 Ventricular Mass, Function, and Tissue Characterization
19.4.1.2 Aortic Root Evaluation
19.4.2 Aortic Regurgitation
19.5 Mitral Valve
19.5.1 Mitral Stenosis
19.5.2 Mitral Regurgitation
19.6 Pulmonary Valve
19.6.1 Pulmonary Stenosis
19.6.2 Pulmonary Regurgitation
19.7 Tricuspid Valve
19.7.1 Tricuspid Stenosis
19.7.2 Tricuspid Regurgitation
19.8 Prosthetic Valves
19.9 Conclusion
References
Part III: Special Topics in CHD
20: Techniques and Clinical Applications of Phase-Contrast MRI in CHD
20.1 Introduction
20.2 Phase-Contrast MRI: Basic Concepts
20.3 Imaging Technique
20.3.1 Basic Scan Parameters
20.3.2 Recommended Velocities
20.4 Planning for Specific Vessels
20.4.1 Ascending Aorta
20.4.2 Main Pulmonary Artery
20.4.3 Branch Pulmonary Arteries
20.4.4 Superior Vena Cava
20.4.5 Descending Aorta
20.4.6 Pulmonary Veins
20.4.7 Atrio Ventricular Valve
20.5 Image Post-processing
20.5.1 Practical Pearls for PC Flow study Post Processing
20.5.2 Internal Checking
20.6 Comparison with Doppler USG
20.7 Pitfalls of PC-MRI and the Remedies
20.7.1 Improper Selection of VENC
20.7.2 Improper Vessel Alignment
20.7.3 Inadequate Temporal Resolution
20.7.4 Inadequate Spatial Resolution
20.7.5 Magnetic Field Inhomogeneity
20.7.6 Flow-Related Signal Loss
20.7.7 Pulsation Artifacts
20.7.8 Phase Offset Error
20.7.9 Prospective Gating
20.8 Clinical Applications of PC-MRI
20.8.1 Presence of Flow
20.8.2 To Know the Direction of Blood Flow
20.8.3 Gradient Across the Stenosis
20.8.4 Calculation of Valve Regurgitation
20.8.4.1 Methods to Calculate Isolated Pulmonary Regurgitant Volume
20.8.4.2 Methods to Calculate Isolated Tricuspid Regurgitant Volume
20.8.5 Calculation of Shunts
20.8.6 Evaluation of Collateral Flow Circulation
20.8.7 Assessment of Differential Lung Perfusion
20.8.8 Velocity Waveforms and Flow Patterns
20.8.8.1 Diastolic Function Assessment by Transmitral Flow
20.8.8.2 Pulmonary Venous PC
20.8.8.3 Assessment of Pulmonary Hypertension
20.8.9 Practical Pearls
20.9 Newer Applications
20.9.1 “Real-Time” Flow Imaging
20.9.2 Coronary Artery Blood Flow (CBF)
20.9.3 3D and 4D Flow
20.10 Conclusions
References
21: Imaging of Pulmonary Hypertension in Congenital Heart Disease
21.1 What Is Pulmonary Hypertension?
21.2 Classification of PH
21.3 Pathophysiology of PH
21.4 Pathophysiology of PAH in CHD
21.5 Prevalence of PAH in CHD
21.6 Cross-Sectional Imaging
21.6.1 CT Protocols
21.6.2 MRI Protocols
21.7 Diagnosis and Detection of PAH
21.7.1 CT Assessment
21.7.2 MRI Assessment
21.8 Functional Assessment
21.8.1 Cine Imaging
21.8.2 Phase-Contrast Imaging
21.8.3 Other Functional Parameters
21.9 Role of CT/MRI in PAH Associated with CHD
21.10 Newer Advances in MRI
21.11 Practical Tips
21.12 Summary
References
22: CT Versus MRI in Congenital Heart Disease
22.1 Introduction
22.2 CT Imaging in CHD
22.2.1 Technical and Equipment Requirements for Cardiac CT
22.2.1.1 Spatial Resolution
22.2.1.2 Temporal Resolution
22.2.1.3 Pitch
22.2.1.4 High-Pitch CT Scan
22.2.1.5 ECG Gated Versus Non-gated Study
22.2.2 Protocoling a CT CHD Study
22.3 MR in Congenital Heart Disease
22.3.1 Morphological Imaging
22.3.2 Cine Imaging
22.3.3 Phase-Contrast Imaging (PC)
22.3.4 Delayed Enhancement Imaging
22.3.5 Contrast-Enhanced Magnetic Resonance Angiography (CE-MRA)
22.3.5.1 3D CE-MRA
22.4 Protocols for Common Conditions (Table 22.1)
22.5 CT Versus CMR for Congenital Heart Disease
22.6 3D Printing
22.7 Imaging in Cardiac Shunts
22.7.1 MRI
22.7.2 Atrial Septal Defects
22.7.2.1 Types of ASD
22.7.2.2 Ostium Primum ASD
22.7.2.3 Ostium Secundum ASD
22.7.2.4 Sinus Venosus ASD
22.7.2.5 Coronary Sinus (CS) Defect
22.7.2.6 CT and MRI: When and Why
22.7.2.7 Practical Pearl
22.7.2.8 Atrioventricular Cushion/Septal Defects (AVCD/AVSD)
22.7.2.9 Types of AVSD
22.7.2.10 CT and MRI: When and Why
22.7.2.11 Practical Pearls
22.7.3 Ventricular Septal Defects
22.7.3.1 Type 1
22.7.3.2 Type 2
22.7.3.3 Type 3
22.7.3.4 Type 4
22.7.3.5 CT and MR: When and Why
22.7.3.6 Practical Pearl
22.8 Venoatrial Anomalies
22.8.1 Partial Anomalous Pulmonary Venous Connection
22.8.2 Total Anomalous Pulmonary Venous Return (TAPVC)
22.8.3 CT and MR Imaging: Where and Why
22.8.3.1 Practical Pearls
22.9 Tetralogy of Fallot (TOF)
22.9.1 Anatomy
22.9.2 Associated Anomalies
22.9.3 CT and MRI: When and Why
22.9.4 CMR in TOF
22.9.5 Practical Pearls
22.10 Double-Outlet Ventricles: DORV
22.10.1 CT and MRI: When and Why
22.11 Transposition of Great Arteries (TGA)
22.11.1 D-TGA (Ventriculoarterial Discordance, Atrioventricular Concordance)
22.11.2 L-TGA or ccTGA (Atrioventricular and Ventriculoarterial Discordance: Double Discordance)
22.11.3 Surgical Modalities in TGA
22.11.4 CT and MRI: When and Why
22.12 Post-surgical TGA
22.12.1 Ebstein’s Anomaly
22.12.2 CT and MRI: When and Why
22.12.3 Carpentier Classification [75]
22.12.4 Practical Pearls
22.13 Coarctation of Aorta (CoA)
22.13.1 CT and MRI: When and Why
22.13.2 Imaging in Repaired Coarctation of Aorta
22.14 Conclusion
References
23: Echocardiography for Congenital Heart Disease: Fundamental Approach
23.1 Introduction
23.2 History of Echocardiography
23.3 Advantages of Echocardiography
23.4 Objectives of Echocardiography
23.5 General Guidelines for Echocardiography
23.6 Optimal Image Acquisition
23.6.1 Choice of Transducer and Frequency
23.6.2 Standardization and Optimization
23.6.3 Imaging Protocols
23.6.4 The Segmental Approach
23.7 Views and Scanning Techniques
23.8 Specific Views
23.8.1 Subxiphoid Views
23.8.2 Subxiphoid Long-Axis Sweep
23.8.3 Subxiphoid Short-Axis Sweep
23.8.4 Apical Views
23.8.5 Parasternal Views
23.8.6 High-Parasternal (“Ductal”) View
23.8.7 Suprasternal Views
23.9 Hemodynamic Assessment
23.10 Summary
References
24: 3D Prototyping: Technology and Applications for CHD
24.1 Introduction
24.2 What Is 3D Printing or Additive Manufacturing?
24.3 Different Types of 3D Printing Technologies and How They Work
24.4 Brief History of Additive Manufacturing
24.5 3D Printing in Medicine and in Cardiovascular Sciences
24.6 Steps in Cardiovascular 3D Printing
24.6.1 Step 1: Imaging
24.6.2 Step 2: Segmentation, Design, and Creation of the Digital 3D Object
24.6.3 Step 3: Consideration of the Printing Technology and Material to Be Used
24.6.4 Step 4: Export of Digital 3D File to 3D Printer Software and Hardware
24.6.5 Step 5: Printing and Post-processing
24.7 Caveats of 3D Models
24.8 Illustrative Case Examples
24.9 Summary
References
25: Radiation Issues in Pediatric Cardiac CT Imaging
25.1 Introduction
25.2 Basic Radiation Dosimetry Parameters
25.2.1 Absorbed Dose
25.2.2 Equivalent Dose
25.2.3 Effective Dose
25.3 Radiation Risks from Performing Cardiac CT in Pediatric Age Group
25.4 Steps for Lowering the Radiation Dose from CT to Pediatric Population
25.4.1 Appropriate Selection of Patient
25.4.2 Patient Centering in the Gantry
25.4.3 Contrast Delivery
25.4.4 Appropriate Coverage
25.4.5 mAs and kVp Settings
25.4.6 Pitch of Scan
25.4.7 Thicker Detector Width
25.4.8 Iterative Reconstruction
25.4.9 Prospective/Retrospective ECG Gating and Non-ECG Pulsing
References