The quantitative data on CMR can be validated by comparing the main pulmonary artery flow to the sum of the branch pulmonary artery flows. CMR using 3-D steady-state free precession navigator respiratory gated sequences can noninvasively evaluate the coronary arteries looking for ostial stenoses or proximal kinking and screen for myocardial injury using perfusion and viability sequences [27,28]. MRI Heart Function with Stress CMR is the most useful imaging modality to screen for myocardial ischemia [28]. CMR coronary angiography can provide good resolution images of coronary lumen especially in adolescents and larger children, but it is inferior in comparison with CTA in young children [26]. Myocardial stress perfusion MRI can also be done when there is a concern for ischemia following arterial switch procedure [28,29]. Radiography Chest Radiography of the chest can be used for the preliminary assessment of stent position, pacemaker and lead position, and as needed during the course of follow-up. SPECT or SPECT/CT MPI Rest and Stress Coronary reimplantation during ASO increases the risk of long-term ischemic complications in the postoperative period. SPECT/CT MPI is used when patient symptoms or ECG findings are concerning for myocardial ischemia [30]. US Echocardiography Transesophageal TEE is useful in patients with poor transthoracic acoustic windows, during intraoperative imaging, and in patients (usually adolescents) who require cardioversion for arrhythmia. It is typically used to assess the adequacy of intraoperative repair. If postoperative access to the transthoracic window is limited, TEE can be used to assess the coronary artery origins and flow patterns in the early postoperative period. Arteriography Coronary with Ventriculography Coronary angiography is traditionally reserved for interventional procedures or when noninvasive diagnostic imaging with CT or MRI is inconclusive. It can correctly identify all types of anomalous coronary arteries.
Congenital or Acquired Heart Disease. The quantitative data on CMR can be validated by comparing the main pulmonary artery flow to the sum of the branch pulmonary artery flows. CMR using 3-D steady-state free precession navigator respiratory gated sequences can noninvasively evaluate the coronary arteries looking for ostial stenoses or proximal kinking and screen for myocardial injury using perfusion and viability sequences [27,28]. MRI Heart Function with Stress CMR is the most useful imaging modality to screen for myocardial ischemia [28]. CMR coronary angiography can provide good resolution images of coronary lumen especially in adolescents and larger children, but it is inferior in comparison with CTA in young children [26]. Myocardial stress perfusion MRI can also be done when there is a concern for ischemia following arterial switch procedure [28,29]. Radiography Chest Radiography of the chest can be used for the preliminary assessment of stent position, pacemaker and lead position, and as needed during the course of follow-up. SPECT or SPECT/CT MPI Rest and Stress Coronary reimplantation during ASO increases the risk of long-term ischemic complications in the postoperative period. SPECT/CT MPI is used when patient symptoms or ECG findings are concerning for myocardial ischemia [30]. US Echocardiography Transesophageal TEE is useful in patients with poor transthoracic acoustic windows, during intraoperative imaging, and in patients (usually adolescents) who require cardioversion for arrhythmia. It is typically used to assess the adequacy of intraoperative repair. If postoperative access to the transthoracic window is limited, TEE can be used to assess the coronary artery origins and flow patterns in the early postoperative period. Arteriography Coronary with Ventriculography Coronary angiography is traditionally reserved for interventional procedures or when noninvasive diagnostic imaging with CT or MRI is inconclusive. It can correctly identify all types of anomalous coronary arteries.