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Abstract: Background: Cardiac magnetic resonance imaging (MRI) and CT are available in the recent era at many pediatric cardiac centers. Objective: The aim was to provide a contemporary description of diagnostic imaging trends for definition of congenital heart disease (CHD). Methods: Echocardiography, cardiac catheterization, cardiac MRI, and cardiac CT use in patients with congenital heart disease at a single institution was retrospectively recorded (2005–2012). Surgical procedures were recorded. Total and modality-specific rates were estimated by Poisson regression and compared. The median age, studies in patients aged >17 years, and referral diagnosis were tabulated for the last year of review. Results: An average of 11,940 cardiovascular diagnostic tests was performed annually. The number of total studies, echocardiograms, catheterizations, and surgical procedures, did not change significantly across time. Echocardiography comprised 95% to 97% of all studies performed during each year of review. The use of cardiac MRI (2%) and cardiac CT (1%) increased linearly (P < .001), and the use of diagnostic catheterization decreased (0.7%; P = .0005). The median age was 3 years for echocardiography, 15 years for MRI, 11 years for CT, and 3 years for catheterization. The percentage of patients aged >17 years was 9% for echocardiography, 33% for cardiac MRI, 29% for cardiac CT, and 8% for catheterization. Most patients undergoing CT, MRI, and diagnostic catheterization had moderate or complex CHD. Conclusion: Cardiac CT is used increasingly in the recent era for evaluation of CHD. The increased use of both cardiac CT and cardiac MRI are temporally associated with a decrease in diagnostic cardiac catheterization. [Copyright &y& Elsevier]

Abstract: Background: Neonates with complex congenital heart disease (CHD) are at risk of adverse events from anesthesia. CT angiography (CTA) performed free breathing and without sedation has not been reported for evaluation of complex CHD in neonates. Objectives: The aim was to evaluate the image quality and risk of free breathing, non-sedated cardiac CTA for definition of CHD in the neonatal period and to determine accuracy compared with interventional findings. Methods: This is a combined retrospective–prospective single institution review of all non-sedated, free breathing cardiac CT angiograms performed in patients <1 month of age with complex CHD. Diagnosis, scan acquisition parameters, image quality (1- to 4-point scale), adverse events, radiation dose estimates, and accuracy compared with operative and interventional catheterization findings were recorded. Results are reported as median and interquartile range. Results: Nineteen non-sedated, free breathing, neonatal cardiac CT angiograms were performed during the time of review. All studies were diagnostic with a mean image quality score of 1.1 ± 0.3. Median total procedural dose-length product was 11 (range, 10–14), CT dose index volume was 0.47 (range, 0.31–0.5). Median unadjusted radiation dose was 0.15 mSv (range, 0.14–0.2 mSv), age- and size-adjusted radiation dose was 0.86 mSv (range, 0.78–1.1 mSv). No adverse events and no discrepancies compared with surgical or catheterization findings were found in the 17 of 19 patients that had subsequent intervention. Conclusions: Cardiac CTA can be performed in the neonatal period free breathing and without sedation. Image quality is excellent, and there is high accuracy compared with surgical and catheterization findings at the time of intervention. [Copyright &y& Elsevier]