Table 4 Examples of scenarios requiring a multimodality diagnostic approach
|
Doppler Echocardiography | Cardiac CT |
Nuclear Scintigraphy |
Cardiac Catheterization | |
|---|---|---|---|---|
| All patients |
• Predicted RV pressure by TR jet velocity • Valve function and interrogation of atrial and ventricular septa by color Doppler | |||
| RV hypertension with RVOT obstruction or branch PA stenosis | Predicted RV pressure by TR jet velocity | Consider if (a) possible benefit from PA balloon dilation and/or stent; or (b) transcatheter PV implantation | ||
| RV hypertension without RVOT obstruction or branch PA stenosis | Assessment of peripheral branch PA stenoses and pulmonary vascular resistance | |||
| Branch PA stenosis without reliable pulmonary flow distribution by CMR | Lung perfusion scan | |||
| Branch PA stenosis with ≤35% flow to one lung | Consideration of balloon dilation with or without stent placement | |||
| Contraindications to CMR or large metallic artifacts |
• Quantitative evaluation of RV size and function • Anatomy of RVOT and branch PAs | |||
| Age >40 years | Coronary angiography before PVR | |||
| Secundum ASD with systemic O2 saturation ≤92% | Hemodynamic assessment ± device closure |