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Children with congenital heart disease account for one in every 145 live births in the UK. Survival has improved dramatically over the past half century; in the 1950s only 20% of such patients could expect to reach adulthood, but now the number is closer to 80%. However, it is a maxim among congenital specialists that a significant proportion of their patients are “fixed, not cured”. There are currently at least 150 000 adults in the UK with congenital heart disease and this number is expected to rise by 25% by 2010. A smaller subset—roughly 12 000 patients—have complex forms of congenital heart disease and numbers are projected to rise by 50% over the same time period.w1
IMAGING IN CONGENITAL HEART DISEASE
A vital component to the multidisciplinary management of the congenital heart disease patient is adequate imaging of the heart and circulation. However, simple anatomical delineation alone is not sufficient. Techniques are required which can measure function, flow and pressure as well as resolve anatomical structures with a high degree of detail. Such methods should be directed by a physician with both knowledge and interest in congenital heart disease.
The major disadvantage of echocardiography has traditionally been its relatively limited field of view. Assessment of an entire congenital repair, which may include extra anatomic bypasses or systemic shunts, is often suboptimal. While central pulmonary arteries are visible there is no opportunity to evaluate the peripheral pulmonary arterial or venous structures. Similarly the tracheobronchial structures and lung parenchyma remain quite occult by this technique.
Cardiac catheterisation remained for many years the reference standard for the investigation of congenital heart disease patients. Radiation dose to this population of children and young adults is a vital consideration, however, given the non-threshold risk of subsequent cancer induction. The European Heart Survey of congenital heart disease, which included over 4000 patients …