Magnetic resonance imaging of congenital heart disease in adults

The clinical application of cardiac magnetic resonance imaging (MRI) in adolescents and adults with congenital heart disease (CHD) has greatly increased over the past decade. Major advances in MRI technology as well as growing evidence from clinical experience indicate that this imaging modality is ideally suited for noninvasive assessment of the cardiovascular system in this patient population. Echocardiography, the most widely used imaging modality in CHD patients, is often limited in adults due to suboptimal acoustic windows. Recent development of new MRI image acquisition methods that are both faster and provide improved temporal and spatial resolutions allows comprehensive noninvasive assessment of cardiovascular anatomy, global and regional ventricular function, myocardial perfusion and viability, quantitative flow analysis and tissue imaging (e.g. cardiac tumors, pericardial anomalies and vessel wall imaging). This manuscript reviews recent advances in cardiovascular MRI and discusses its application to adolescents and adults before and after treatment of CHD. The role of MRI in patients with tetralogy of Fallot, aortic arch anomalies and Fontan circulation is discussed in detail to illustrate its clinical utility.