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Cardiovascular computer tomography (CT) in pediatric congenital heart disease (CHD) patients is often challenging. This might be due to limited patient cooperation, the high heart rate, the complexity and variety of diseases and the need for radiation dose minimization. The recent developments in CT technology with the introduction of the third-generation dual-source (DS) dual-energy (DE) CT scanners well suited to respond to these challenges. DSCT is characterized by high-pitch, long anatomic coverage and a more flexible electrocardiogram-synchronized scan. DE provides additional clinical information about vascular structures, myocardial and lung perfusion and allows artifacts reduction. These advances have increased clinical indications and modified CT protocol for pediatric CHD patients. In our hospital, DSCT with DE technology has rapidly become an important imaging technique for both pre- and postoperative management of pediatric patients with CHDs. The aim of this article is to describe the state-of-the-art in DSCT protocol with DE technology in pediatric CHD patients, providing some case examples of our experience over an 18-month period.

The number of patients with congenital heart disease (CHD) is rapidly increasing in the adult population, mainly due to the improved long-term survival. Serial follow-up with cardiac magnetic resonance imaging (CMR) is very appealing due to its non-invasive nature. CMR exam is able to provide specific information about cardiac function, hemodynamics, anatomy and tissue characterization unlikely achievable by other diagnostic techniques. CMR in CHD plays a role both in early diagnosis and in post-operative follow-up. Black Blood T1 weighted sequences are used to acquire morphological information. Cine Steady State Free Precession sequences are mainly used to provide data about cardiac function and kinesis. Hemodynamic assessment is routinely performed using phase contrast sequences, which provide reliable information concerning vessel flow pattern, cardiac output and intracardiac shunts. Magnetic Resonance Angiography (MRA) and 3D coronary MRA of the whole thorax can provide detailed morphological information regarding great vessels and proximal coronary arteries. Presence of late gadolinium enhancement suggesting myocardial macroscopic fibrosis seems to play a prognostic and diagnostic role even in this field.