Advances in Image Diagnosis for Adult Congenital Heart Diseases

Many children suffering from congenital heart diseases (CHD) have grown into adults due to advances in medical management and improved outcomes. Patients with these adult CHD require continuous follow-up and treatment. In Japan, it is surmised that there are currently 500,000 adult CHD patients. This exceeds the number of annual myocardial infarction patients. Consequently, adult CHD is already considered one field of cardiovascular internal medicine. Although cases referred from the Department of pediatric cardiology are already diagnosed, when patients who discontinued follow-ups visit us as emergency patients, it becomes necessary to gain an understanding of the structure. Some adult CHD patients are not informed of the disease name. Oftentimes, the results from anatomical diagnoses and echocardiograms of CHD are used along with segmental approaches by diagnosing the major blood vessels, ventricular looping, and the position of the internal organs and the atrium; however, this is an anatomical concept that uses complicated language which is difficult for doctors in the Department of Cardiovascular Internal Medicine to understand. Therefore, when it comes to diagnosis and surgery, a relatively easy diagnosis can be made by diagnosing with a focus on the position of internal organs and the atrium, the position of the major blood vessels, diagnosis of the atrium, the relation between the atrium and the ventricle, and the major blood vessels of the atrium. In postoperative cases, diagnosis is possible by focusing on whether the case is biventricular or involves a functional single ventricle, whether the systemic ventricle is the right or left ventricle, and whether it involves the major blood vessels or pulmonary artery. If able to gain an understanding of the intracardiac structure, subsequently proceed to understanding the function. The bodily and ventricular functions and outflow tract are evaluated (stricture and dysraphism), and the presence of pulmonary hypertension is diagnosed. However, depiction under transthoracic echocardiogram is poor in many adult congenital heart disease patients who have undergone several cardiac surgeries since infancy using normal echocardiograms of the pulmonary artery. In such cases, it is necessary to use a plurality of modalities in combination such as a transesophageal echocardiogram, CT, MRI, SPECT, angiography, etc. to make an accurate diagnosis. It becomes possible to accurately diagnose the structure and function of adult CHD patients by using multiple modalities and creating a treatment strategy. In this symposium, we hope experts in diagnosis modality will present their approaches to adult CHD for discussion.