Structural Interventional Planning

The life expectancy of children with congenital heart disease has increased dramatically due to successful early treatment. This has caused a higher incidence of recurrent anatomical and functional defects, which require structural cardiac interventions. Structural interventions comprise minimally invasive and percutaneous techniques, which can also be applied to adults with uncorrected congenital heart defects. Multimodality imaging before and during the procedure is key to the successful implementation of structural heart interventions for adult congenital heart disease (ACHD). This chapter reviews the role of multimodality imaging in structural interventional planning for a variety of common (e.g. atrial septal defect) and less common (e.g. congenital pulmonary stenosis) ACHD. Echocardiography, cardiac computed tomography and cardiac magnetic resonance imaging are discussed, with practical examples of ACHD entities where these techniques have an important role to play. The specific advantages of the various modalities in the planning and execution of structural heart disease interventions in ACHD are highlighted. Potential future directions are discussed briefly, e.g. three-dimensional printing, virtual/augmented reality and the application of deformation imaging and four-dimensional flow.