The Congenital Heart Disease You May be Missing: Limitations of Standard Protocols, and When Should We Be Suspicious-The Congenital Heart Disease You May be Missing: Limitations of Standard Protocols, and When Should We Be Suspicious

The Congenital Heart Disease You May be Missing: Limitations of Standard Protocols, and When Should We Be Suspicious

Video Transcription

Video Summary

The webinar focused on detecting previously undiagnosed congenital heart disease (CHD) in adults using cardiac MRI, especially when standard protocols are aimed at other diagnoses. Speakers highlighted the growing adult congenital population and the risks of missed CHD, including delayed treatment and persistent symptoms.<br /><br />Cases illustrated several diagnostic pitfalls. A patient with an apparent atrial septal defect was found to have a superior sinus venosus defect with anomalous pulmonary venous return; thin, gap-free imaging and angiographic sequences can help define this anatomy for surgical or catheter-based repair. Another patient treated for presumed pulmonary hypertension had double-chambered right ventricle, which was revealed by dedicated right ventricular outflow tract imaging and flow assessment.<br /><br />Further cases showed that left ventricular enlargement may reflect a patent ductus arteriosus, and that severe aortic coarctation can contribute to ventricular dysfunction—even in an athlete and alongside a genetic cardiomyopathy. Survey and black-blood images, targeted angiography, and flow measurements can prompt appropriate changes to a protocol without routinely adding substantial scan time.<br /><br />Key recommendations included reviewing survey images carefully, considering shunts when either ventricle is enlarged, using thin slices without gaps, and checking both the quality and pattern of phase-contrast flow data. When findings are inconsistent or incomplete, further imaging should be considered. The discussion emphasized adapting protocols to clinical clues and local expertise, with MRI, CT, echocardiography, and advanced imaging each playing a role.

Keywords

congenital heart disease

cardiac MRI

adult congenital heart disease

sinus venosus defect

anomalous pulmonary venous return

double-chambered right ventricle

patent ductus arteriosus

aortic coarctation

phase-contrast flow

shunt detection