Table 1

Comparison of imaging modalities in CHD

Imaging modalityAdvantagesDisadvantages
Two-dimensional transthoracic echocardiography (2D TTE)*
  • Well validated, affordable and widely available.

  • Can assess valves and subvalvular apparatus.

  • Offers full haemodynamic assessment.

  • RV strain analysis.

  • Image quality limited by poor acoustic windows.

  • Limited spatial resolution as compared with other techniques.

  • May not detect all cardiac metastases.

Three-dimensional transthoracic echocardiographyf three‐dimensional transoesophageal echocardiography

  • Can be used as adjunct to 2D TTE for better visualisation of all valve leaflets and subvalvular apparatus.

Transoesophageal echocardiography/three‐dimensional transoesophageal echocardiograph
  • Can assess valves when transthoracic window is suboptimal.

  • Improved visualisation of the pulmonic valve in particular.

Cardiac MRI
  • May improve visualisation of valves compared with echocardiography.

  • Accurate assessment of regurgitant volumes and chamber sizes.

  • Identification of myocardial metastasis.

  • Increased cost, compared with echocardiography.

  • Contrast exposure.

Cardiac CT
  • Accurate assessment of RV size.

  • Can assess severity of structural valvular damage/degree of calcification.

  • Operative planning: can assess coronary arteries and their proximity to myocardial metastases.

  • Radiation exposure±contrast exposure.

Positron emission tomography
  • Highly sensitive and specific for myocardial metastasis.

  • Not readily performed due to high cost, limited availability.

  • *Two dimensional transthoracic echocardiography is initial test of choice for CHD.

  • CHD, carcinoid heart disease; RV, right ventricle.