Diagnostic Tools in Adult Congenital Heart Disease

Although the principles of imaging congenital heart disease are the same in adults and children, the keys to successful imaging sometimes differ because imaging modalities perform differently at varying ages. For example, cross-sectional imaging with cardiac MRI or CT is usually straightforward in an adult, while echocardiographic windows often deteriorate, which may limit its utility in surveillance imaging. The clinical questions on which a study is focused may also evolve, which may alter the relevance of specific tools such as tissue Doppler assessment of diastolic function or myocardial strain assessment of ventricular function. This chapter aims to highlight areas in which assessment of the adult with congenital heart disease differs from that of a pediatric patient. Sometimes this difference will reflect differences in how a given technique performs in adults versus children. In other situations, the differences in imaging priorities reflect differences in the clinical scenarios and questions relevant to the adult vs. pediatric patient.