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Assessing outcomes after paediatric cardiac surgery: which test is best?
  1. Albert de Roos
  1. Correspondence to Albert de Roos, Leiden University Medical Centre, Albinusdreef 2, Leiden University Medical Centre, Leiden 2300 RC, The Netherlands; a.de_roos{at}lumc.nl

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Imaging techniques are routinely used in the evaluation and follow-up of paediatric patients with a variety of congenital heart diseases. The selection of the ‘best test’ in these patients will depend on a number of factors, including the medical relevance of the outcome parameters for prognosis and guiding treatment options, the accuracy and reproducibility for measuring key parameters, the perceived pathophysiological implications of those measurements, the experience and preference of clinicians as to how to use the information, the convenience for the patient to undergo a specific test, the non-invasiveness and lack of complications of the test, the costs and the availability.

Cardiac ultrasound may fulfil most of these requirements and has traditionally been the most widely applied and accepted non-invasive imaging tool in diagnosis and follow-up of patients with congenital heart disease. Is there a need for other non-invasive imaging tests and do diagnostic tools, like MRI, offer better, just the same or perhaps slightly different parameters than those we get from ultrasound? Is there also a role for cardiovascular multidetector computed tomography (MDCT) for evaluating congenital heart disease?

MRI provides a large number of measurements of cardiac function and structure that are similar to those of cardiac ultrasound. The estimation of ventricular ejection fraction, assessment of cardiac dimensions, analysis of flow profiles across valves, estimation of diastolic functional parameters and filling pressures rely on similar approaches for MRI and ultrasound. The main advantage of ultrasound over MRI is the real-time capability, easy access and wide acceptance in routine practice. The main advantage of MRI over ultrasound is its three-dimensional representation, providing anatomical and functional data with very high image quality, thereby allowing direct measurements of key parameters that may be …

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