TABLE 1.
Novel Imaging Techniques in Congenital Heart Disease (CHD): Current Clinical Validation and Outcome Benefits
| Imaging Technique | Validation | Outcome Benefits |
|---|---|---|
| 3D echocardiography (3DE) | ||
| Novel rendering techniques |
Validated in adults and CHD in small single-center studies |
Accurate identification of orifices and borders, improved accuracy in diagnosis of valve anormalities5–8 |
| Novel 3D transesophageal echocardiography probe | Preliminary reports in pediatric CHD | Real-time 3DE guidance of transcatheter intervention, improved evaluation of valve pathology3 |
| Ultrafast ultrasound | ||
| Ventricular and vascular function | Research only | Not available |
| Myocardial and brain perfusion | Research only | Not available |
| Intracardiac flow dynamics | Early clinical use | Not available |
| Cardiac magnetic resonance imaging (CMR) | ||
| Cine imaging and 4D flow | ● Good agreement with flow according to 2D phase-contrast measurements | ● Comprehensive flow and shunts assessments in complex CHD23 ● Flow characteristics and blood-tissue interactions may predict aortic dissection21 ● Quantification of atrioventricular valve regurgitation22 |
| Tissue characterization | ● Agreement with quantification of diffuse myocardial fibrosis on histology ● Correlation with systolic and diastolic dysfunction as well as adverse outcomes |
● Markers of diffuse fibrosis as early indicators of myocardial remodeling27 ● T1 tissue characterization is a confirmatory test for childhood myocarditis37 ● Detection of heart transplant rejection38 |
| Lymphangiography | ● Findings complementary to those by fluoroscopic lymphangiography | ● Greater lymphatic burden by T2 imaging is associated with adverse outcomes in single-ventricle patients, including Fontan failure48 |
| Cardiac computed tomography (CCT) | ||
| Radiation dose optimization | Accepted clinical practice | Decreased radiation dose for CCT50,51 |
| Photon counting | Preliminary reports in CHD patients | Improved spatial resolution, lower radiation, metal artifact reduction57 |
| Coronary fractional flow reserve for anomalous aortic origin of a coronary artery (AAOCA) | Case reports only | May predict hemodynamic significance of AAOCA60,61 |
| Catheterization | ||
| Fusion imaging | Accepted clinical practice | ● Decrease in fluoroscopy time74 and radiation exposure75 |
| 3D rotational angiography | Accepted clinical practice | ● Decrease in radiation exposure65 ● Improved diagnostic accuracy over 2D angiography65 |
| Interventional CMR | Preliminary reports in CHD patients | ● Decrease in radiation exposure77,79 |
| 3D visualization | ||
| 3D printing | RCT in complex CHD, multiple case series in CHD, VAD, structural cardiac disease | ● Improved surgical approach in complex CHD93 ● Improved visualization of deployed interventional devices99 |
| Virtual procedural planning | Multiple case series and small single-center RCT | ● Improve device selection in catheter-based therapies97 ● Improve surgical approach in CHD and other open heart surgical procedures101,102 ● Decrease planning time and increase accuracy99 |
RCT = randomized controlled trial; VAD = ventricular assist device.