Role of CT scan in newborns and infants with congenital heart disease

Background and Aim: Improvements in diagnostic techniques brought to a better understanding of congenital heart disease (CHD), thus allowing a more comprehensive clinical and surgical management. Echocardiography (Echo) is the first imaging modality because of easy availability, limited costs and safety. A larger interest in the use of computed tomography scan (CT) has been achieved, although its application is generally limited because of safety concerns and low image quality. We aimed to evaluate differences in diagnostic performance of Echo and CT, to investigate how clinical and surgical management are affected, accordingly to each imaging technique. Method: Retrospective longitudinal single center study, involving 22 patients aged <1 year (11 newborns, 11 infants) diagnosed with CHD between 2020-2023. Newborns diagnosed with CHD undergone Echo (mean age 1.5 days) and results were discussed to evaluate future surgical plan. For those whose cardiac anatomy was challenging a CT was performed (mean age 10 days). Infants diagnosed with CHD underwent CT as part of the surgical planning (mean age 162.91 days). CT data were compared to the most recent Echo assessment. Main indications to perform advanced imaging were revised. Results: In newborn population main indications for CT were: evaluation of coronary artery anatomy (4), multiple aorto-pulmonary artery collaterals (2), great vessels abnormalities (3 aortic arch anomalies, 1 pulmonary artery anomaly, 1 anomalous venous return). Good agreement Echo vs CT in 6 cases, while in 5 cases CT added details to diagnosis. In infants CT was performed in case of challenging coronary artery anatomy (2), anomalous venous returns (3); better definition of intracardiac anatomy (6). In 7 cases Echo and CT reports were comparable, whereas disagreed in 4 cases, mainly due to coronary artery anomalies and definition of pulmonary venous return anatomy. Only in one case CT findings significantly changed the surgical plan for patients. Conclusions: Intracardiac anatomy is well depicted either by Echo or CT. CT plays an incremental role in the assessment of extra-cardiac and vascular anatomies, notoriously difficult to be assessed by Echo. Echo is superior to CT to assess valvular anatomy and function. Multimodality imaging is of paramount importance to plan surgical and interventional management of complex CHD.