Routine clinical cardiovascular magnetic resonance in paediatric and adult congenital heart disease: patients, protocols, questions asked and contributions made

Underlying diagnosis was in 33% Fallot's tetralogy, 17% aortic coarctation, 8% Ebstein's disease, 6% Marfan's disease, 4% single ventricle with Fontan-like circulation, and 32% others. Median age was 26 years (7 days – 75 years). Ventricular volumes were assessed in 67% of the patients; flow in 74%; unknown anatomy only in 9%; specific individual morphology of known anatomy in 83%; myocardial fibrosis in 8%; stress-induced myocardial perfusion defects in 1%. Only in 3% of the cases the question could not be fully answered.Contrary to common belief, routine CMR of patients with CHD was not requested to address global anatomical questions so much as to clarify specific questions of morphology and function of known anatomy. The CMR protocols used differed markedly from those widely used in patients with ischemic heart disease.Moderate to severe forms of congenital heart disease (CHD) are found in about 6 of 1,000 live births[1]. All forms of CHD represent 7 to 19 of 1,000 live births [1-3]. As a result of the success of paediatric cardiology and cardiac surgery over the last three decades, there will shortly be more adults than children with CHD[4]. There are currently estimated to be at least 120,000 adults in Germany with CHD and this number is expected to rise by about 5,500 per year[5]. The number of patients with complex forms of CHD are expected to rise by about 50% within the next few years[6]. A vital component to the multidisciplinary management of the CHD patient is Cardiovascular Magnetic Resonance (CMR). CMR of patients with CHD has become routine practice during the last few years[7]. However, the majority of clinically used CMR protocols focus on adults with ischemic heart disease and relatively little information is available on protocols for patients with CHD[8,9]. Although general guidelines for CMR of patients with CHD have been developed[7,9,10], guidelines addressing the range of types of CHD have not. Nor has the range of CHD questions addressed by