SPECT or SPECT/CT MPI Rest and Stress There is no relevant literature to support the use of SPECT or SPECT/CT MPI rest and stress in the evaluation of known or suspected anomalous pulmonary venous return with inadequate evaluation after TTE. US Echocardiography Transesophageal TEE can be used in cases of PAPVC in which TTE does not completely delineate the partial veins and cardiac chamber enlargement [72,73]. However, the procedure is more invasive than CT or MRI, and it can suffer from Congenital or Acquired Heart Disease airways obscuring some of the acoustic windows, especially for anomalous venous drainage that occurs superior to the right atrium. TEE is also less accurate than MRI for some pulmonary vein anatomy and shunt quantification [72]. TEE has just recently been shown to be safe in patients with TAPVC, but only after median sternotomy [74]. There is no published role for TEE as the most useful imaging modality after an insufficient TTE with suspicion for TAPVC. Variant 9: Child or adult. Suspected aortic coarctation with inadequate evaluation after transthoracic echocardiography. Next imaging study. Coarctation of aorta (CoA) refers to discrete or diffuse narrowing in the aorta causing obstruction to the flow of blood. It accounts for 6% to 8% of all CHDs [75]. Aortic coarctation can be more commonly associated with other cardiac lesions such as bicuspid aortic valve, aortic arch hypoplasia, aberrant aortic branch vessels, and other intracardiac and conotruncal defects. This variant will focus on imaging recommendations for aortic coarctation and associated aortic arch pathology. If a patient has associated intracardiac or conotruncal abnormalities, please refer to those variants for recommendations on how to image those concurrent diseases. Aortic coarctation is managed by surgical treatment, transcatheter balloon angioplasty, and transcatheter stent placement.
Congenital or Acquired Heart Disease. SPECT or SPECT/CT MPI Rest and Stress There is no relevant literature to support the use of SPECT or SPECT/CT MPI rest and stress in the evaluation of known or suspected anomalous pulmonary venous return with inadequate evaluation after TTE. US Echocardiography Transesophageal TEE can be used in cases of PAPVC in which TTE does not completely delineate the partial veins and cardiac chamber enlargement [72,73]. However, the procedure is more invasive than CT or MRI, and it can suffer from Congenital or Acquired Heart Disease airways obscuring some of the acoustic windows, especially for anomalous venous drainage that occurs superior to the right atrium. TEE is also less accurate than MRI for some pulmonary vein anatomy and shunt quantification [72]. TEE has just recently been shown to be safe in patients with TAPVC, but only after median sternotomy [74]. There is no published role for TEE as the most useful imaging modality after an insufficient TTE with suspicion for TAPVC. Variant 9: Child or adult. Suspected aortic coarctation with inadequate evaluation after transthoracic echocardiography. Next imaging study. Coarctation of aorta (CoA) refers to discrete or diffuse narrowing in the aorta causing obstruction to the flow of blood. It accounts for 6% to 8% of all CHDs [75]. Aortic coarctation can be more commonly associated with other cardiac lesions such as bicuspid aortic valve, aortic arch hypoplasia, aberrant aortic branch vessels, and other intracardiac and conotruncal defects. This variant will focus on imaging recommendations for aortic coarctation and associated aortic arch pathology. If a patient has associated intracardiac or conotruncal abnormalities, please refer to those variants for recommendations on how to image those concurrent diseases. Aortic coarctation is managed by surgical treatment, transcatheter balloon angioplasty, and transcatheter stent placement.