II. Imaging: First Line tests (all cases of suspected CHD)
III. Imaging: Second-line tests (preferred)
-
Magnetic Resonance Imaging (MRI Chest)
- Advantages
- Best consistent, operator and habitus-independent anatomic and functional information
- Evaluates shunts, pressure gradients, and other abnormal flow patterns (as opposed to CT)
- Uniquely shows complex congenital lesions, right ventricular outflow, pulmonary arteries and left to right shunts
- Disadvantages
- Nephrogenic Systemic Fibrosis risk (when GFR is <30)
- Contraindicated with implanted metals such as Pacemakers
- Advantages
- Computed Tomography (CT Chest)
- Advantages
- Cardiac Gated CT provides functional information
- CT Angiography identifies Anomalous Coronary Vessels
- Disadvantages
- CT-associated Radiation Exposure
- Iodinated Contrast Material exposure
- Advantages
IV. Imaging: Third-line and alternative studies
- Radionuclide Imaging (nuclear scintography)
- Advantages
- Alternative evaluation of Cardiac Anatomy and function when MRI is contraindicated
- Evaluates for comorbid ischemic cardiac disease when combined with stress testing
- Disadvantages
- MRI offers better anatomic and functional information
- Advantages
-
Transesophageal Echocardiogram
- Advantages
- Best evaluates intracardiac anatomy
- Disadvantages
- Invasive
- Advantages
- Cardiac catheterization and angiography
- Advantages
- Historically the gold standard for coronary and pulmonary vascular evaluation (especially preoperatively)
- Disadvantages
- Invasive with risk of complication
- MRI and other Cardiac Imaging may be used as safer alternative preoperative evaluation for selected CHD conditions
- Advantages