Table 4.
Examples of scenarios requiring a multimodality diagnostic approach
| Doppler Echocardiography |
Cardiac CT | Nuclear Scintigraphy |
Cardiac Catheterization |
|
|---|---|---|---|---|
| All patients | • Predicted RV pressure by TR jet velocity • Valve function and interrogation of atrial and ventricular septa by color Doppler |
|||
| RV hypertension with RVOT obstruction or branch PA stenosis | Predicted RV pressure by TR jet velocity | Consider if (a) possible benefit from PA balloon dilation and/or stent; or (b) transcatheter PV implantation | ||
| RV hypertension without RVOT obstruction or branch PA stenosis | Assessment of peripheral branch PA stenoses and pulmonary vascular resistance | |||
| Branch PA stenosis without reliable pulmonary flow distribution by CMR | Lung perfusion scan | |||
| Branch PA stenosis with ≤35% flow to one lung | Consideration of balloon dilation with or without stent placement | |||
| Contraindications to CMR or large metallic artifacts | • Quantitative evaluation of RV size and function • Anatomy of RVOT and branch PAs |
|||
| Age >40 years | Coronary angiography before PVR | |||
| Secundum ASD with systemic O2 saturation ≤92% | Hemodynamic assessment ± device closure | |||
ASD = atrial septal defect; PA = pulmonary artery; PV = pulmonary valve; PVR = pulmonary valve replacement; RV = right ventricle; RVOT = right ventricular outflow tract; TR = tricuspid regurgitation