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Table 16 Recommendations for CMR for management of adults with congenital heart disease

From: Representation of cardiovascular magnetic resonance in the AHA / ACC guidelines

  Classa Levelb Page
Recommendations for adults with congenital heart disease (ACHD)    
 Diagnostic and interventional procedures, including imaging (ie, echocardiography, MRI, or CT, advanced cardiac catheterization, and electrophysiology procedures for adults with complex and moderate CHD should be performed in a regional ACHD center with appropriate experience in CHD and in a laboratory with appropriate personnel and equipment. Personnel performing such procedures should work as part of a team with expertise in the surgical and transcatheter management of patients with CHD. I C 12–13
Bicuspid aortic valve disease    
 MRI/CT can be beneficial to add important information about the anatomy of the thoracic aorta. IIa C 45
 MRI may be beneficial in quantifying aortic regurgitation when other data are ambiguous or borderline. IIb C 45
Supravalvular aortic stenosis    
 TTE and/or TEE with Doppler and either MRI or CT should be performed to assess the anatomy of the LVOT, the ascending aorta, coronary artery anatomy and flow, and main and branch pulmonary artery anatomy and flow. I C 50
Aortic coarctation    
 Every patient with coarctation (repaired or not) should have at least 1 cardiovascular MRI or CT scan for complete evaluation of the thoracic aorta and intracranial vessels. I B 52
 Evaluation of the coarctation repair site by MRI/CT should be performed at intervals of 5 years or less, depending on the specific anatomic findings before and after repair. I C 53
 Supravalvular, branch, and peripheral pulmonary stenosis    
 Patients with suspected supravalvular, branch, or peripheral pulmonary stenosis should have baseline imaging with echocardiography-Doppler plus 1 of the following: MRI angiography, CT angiography, or contrast angiography. I C 61
Congenital coronary anomalies of ectopic arterial origin    
 CT or MRA is useful as the initial screening method in centers with expertise in such imaging. I B 65
Coronary arteriovenous fistula    
 If a continuous murmur is present, its origin should be defined either by echocardiography, MRI, CT angiography, or cardiac catheterization. I C 67
Congenital heart disease and pulmonary arterial hypertension    
 The evaluation of all ACHD patients with suspected pulmonary arterial hypertension should include noninvasive assessment of cardiovascular anatomy and potential shunting, as detailed below: Diagnostic cardiovascular imaging via TTE, TEE, MRI, or CT as appropriate. I C 70
After repaired of tetralogy of Fallot    
 Patients with tetralogy of Fallot should have echocardiographic examinations and/or MRIs performed by staff with expertise in ACHD. I C 73
Dextro-Transposition of the great arteries    
 Additional imaging with TEE, CT, or MRI, as appropriate, should be performed in a regional ACHD center to evaluate the great arteries and veins, as well as ventricular function, in patients with prior atrial baffle repair of d-TGA. I B 80
 Periodic MRI or CT can be considered appropriate to evaluate the anatomy and hemodynamics in more detail in patients with prior arterial switch operation. IIa C 80
Congenitally corrected transposition of the great arteries    
 Echocardiography-Doppler study and/or MRI should be performed yearly or at least every other year by staff trained in imaging complex CHD. I C 87
 The following diagnostic evaluations are recommended for patients with congenitally corrected transposition of the great arteries: ECG, chest x-ray, echocardiography-Doppler study, MRI, exercise testing. I C 87
 In patients with prior repair of congenitally corrected transposition of the great arteries, echocardiography-Doppler study and/or MRI should be performed yearly or at least every other year by staff trained in imaging complex CHD. I C 89
After Fontan Procedure    
 All patients with prior Fontan type of repair should have periodic echocardiographic and/or magnetic resonance examinations performed by staff with expertise in ACHD. I C 97
  1. aClass of recommendation
  2. bLevel of evidence