New AUC Address Multimodality Imaging During Follow-Up Care of CHD Patients

Thanks to major medical advances, patients with congenital heart disease (CHD) are living longer, healthier lives. However, most need lifelong follow-up to monitor surgical interventions and avoid or minimize the development of complications over time. New Appropriate Use Criteria (AUC) from the ACC, published Jan. 6 in the Journal of the American College of Cardiology, provide important guidance on the appropriate use of noninvasive cardiac imaging for surveillance and evaluation of this unique patient population.

The new AUC address 1,035 unique scenarios that include 324 clinical indications and up to seven imaging modalities offered per indication. Of these scenarios, 44 percent were rated "appropriate," 39 percent were rated "may be appropriate," and 17 percent were rated "rarely appropriate."

The document is broken down into 19 tables by the following clinical indications: Patent Foramen Ovale, Atrial Septal Defects and Partial Anomalous Pulmonary Venous Connection; Ventricular Septal Defects; Atrioventricular Septal Defects; Patent Ductus Arteriosus; Total Anomalous Pulmonary Venous Connection; Eisenmenger Syndrome and Pulmonary Hypertension Associated With CHD; Ebstein Anomoly and Tricuspid Valve Dysplasia; Pulmonary Stenosis; Pulmonary Atresia With Intact Ventricular Septum; Mitral Valve Disease; LVOT Lesions; Truncus Arteriosus; Single Ventricle Heart Disease; Aortic Coarctation and Interrupted Aortic Arch; Coronary Anomalies; Tetralogy of Fallot; Double Outlet Right Ventricle; D-Loop Transposition of the Great Arteries; and Congenitally Corrected Transposition of the Great Arteries.

The writing group, co-chaired by Ritu Sachdeva, MBBS, FACC, and Anne Marie Valente, MD, FACC, noted that in general, "while transthoracic echocardiography remains the cornerstone of cardiac imaging in patients with CHD, other imaging modalities, such as transesophageal echocardiography, cardiovascular magnetic resonance, cardiovascular computed tomography, and stress imaging, also play an important role in anatomic and functional assessment."

"As lesion complexity increased, additional imaging modalities received higher appropriateness ratings," explain Sachdeva, et al.

They conclude that while the scope of the document was purposefully limited to more common scenarios encountered when managing and treating established CHD patients, the hope is to help clarify appropriate use of multimodality imaging in these scenarios and help to minimize the significant variability in use that currently exists.

The AUC document was developed with the American Heart Association, American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Pediatric Echocardiography.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Valvular Heart Disease, Atrial Fibrillation/Supraventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Imaging, CHD and Pediatrics and Interventions, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Pulmonary Hypertension, Interventions and Imaging, Interventions and Structural Heart Disease, Interventions and Vascular Medicine, Angiography, Echocardiography/Ultrasound, Nuclear Imaging, Hypertension

Keywords: Child, Heart Defects, Congenital, American Heart Association, Heart Septal Defects, Ventricular, Truncus Arteriosus, Double Outlet Right Ventricle, Echocardiography, Transesophageal, Eisenmenger Complex, Ductus Arteriosus, Patent, Aortic Coarctation, Foramen Ovale, Patent, Mitral Valve, Aftercare, Aorta, Thoracic, Area Under Curve, Atrial Fibrillation, Follow-Up Studies, Tetralogy of Fallot, Transposition of Great Vessels, Tricuspid Valve, Heart Septal Defects, Echocardiography, Multimodal Imaging, Truncus Arteriosus, Persistent, Angiography, Hypertension, Pulmonary, Magnetic Resonance Spectroscopy, Pulmonary Valve Stenosis, Tomography

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