II. Imaging: First Line tests (all cases of suspected CHD)

III. Imaging: Second-line tests (preferred)

  1. Magnetic Resonance Imaging (MRI Chest)
    1. Advantages
      1. Best consistent, operator and habitus-independent anatomic and functional information
      2. Evaluates shunts, pressure gradients, and other abnormal flow patterns (as opposed to CT)
      3. Uniquely shows complex congenital lesions, right ventricular outflow, pulmonary arteries and left to right shunts
    2. Disadvantages
      1. Nephrogenic Systemic Fibrosis risk (when GFR is <30)
      2. Contraindicated with implanted metals such as Pacemakers
  2. Computed Tomography (CT Chest)
    1. Advantages
      1. Cardiac Gated CT provides functional information
      2. CT Angiography identifies Anomalous Coronary Vessels
    2. Disadvantages
      1. CT-associated Radiation Exposure
      2. Iodinated Contrast Material exposure

IV. Imaging: Third-line and alternative studies

  1. Radionuclide Imaging (nuclear scintography)
    1. Advantages
      1. Alternative evaluation of Cardiac Anatomy and function when MRI is contraindicated
      2. Evaluates for comorbid ischemic cardiac disease when combined with stress testing
    2. Disadvantages
      1. MRI offers better anatomic and functional information
  2. Transesophageal Echocardiogram
    1. Advantages
      1. Best evaluates intracardiac anatomy
    2. Disadvantages
      1. Invasive
  3. Cardiac catheterization and angiography
    1. Advantages
      1. Historically the gold standard for coronary and pulmonary vascular evaluation (especially preoperatively)
    2. Disadvantages
      1. Invasive with risk of complication
      2. MRI and other Cardiac Imaging may be used as safer alternative preoperative evaluation for selected CHD conditions

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