Repair of Congenital Heart Disease: A Primer—Part 2

Abstract

This review, the second of two parts, describes the repair of aortic arch anomalies, left-to-right shunts, valvular disease, tetralogy of Fallot, and truncus arteriosus. Cardiac transplantation is also discussed. Advances in the surgical management of congenital heart disease have led to improved patient survival and quality of life. Improvements in technology in computed tomography and magnetic resonance imaging have resulted in increasing utilization of cross-sectional imaging in these patients. Perioperative care necessitates that radiologists have a basic understanding of the surgical treatment and the resultant postoperative anatomy. Because many patients with treated congenital heart disease are being followed up into the 4th and 5th decades of life, this is information that will fall within the domain of all radiologists who interpret cross-sectional images of the thorax.

Cardiac causes of pulmonary arterial hypertension: assessment with multidetector CT

“…Occasionally, the communication is located inferiorly in relation to the inferior vena cava (IVC) orifice [36]. Sinus venosus ASD is associated with partial anomalous pulmonary venous return (PAPVR) in 80-90% of cases, which most often involves drainage of the right superior pulmonary vein into the right atrium or SVC [37,38]. Sinus venosus defects are associated with a high left to right shunt fraction, especially when in association with PAPVR, and are up to three times more likely to cause PAH than a secundum ASD (12% vs 4%) [39].…”

“…The assessment, classification and reparative techniques are beyond the scope of this article, but interested readers are directed to several excellent reviews, which comprehensively cover these aspects of CHD [37,51,57,58]. What follows is an overview of some of the more commonly encountered complex cardiac defects causing PAH in adulthood.…”

“…This common trunk straddles a high VSD and has a single valve with a variable number of leaflets. Because both systemic and pulmonary blood flow arise from a single outlet the pulmonary flow is excessive and most patients develop PAH if not operated on during the first year of life [37]. Truncus arteriosus may sometimes be palliated with pulmonary artery banding to limit flow, but more often surgical repair is undertaken [37].…”

MRI of complex cyanotic congenital heart disease: pre- and post surgical considerations

“…Most adult patients with complex cyanotic heart disease have undergone palliative shunt or definitive repair of their lesions in infancy or early childhood [4][5][6][7][8][9][10]. Patients come to clinical attention later in life due to post-operative complications.…”

“…Patients come to clinical attention later in life due to post-operative complications. MRI plays a role in delineation of underlying anatomy, patency of surgical shunts, and surgical complications before additional therapy is instituted [4][5][6][7][8][9][10]. We describe major complex congenital heart lesions and surgical complications below.…”