Pediatric Cardiac Imaging

Your child’s doctors will consider your their symptoms, medical and cardiac history, age, and risk factors to determine what type of imaging is best. 

Echocardiography
This is an ultrasound of the heart that uses high-frequency sound waves to produce moving images of different heart structures, heart function, and blood flow. Types of echocardiography include the following:

• Fetal echo is performed by fetal cardiology experts before your baby is born, as early as week 12 of pregnancy. This test is completely non-invasive, as the ultrasound probe (called a transducer) is placed on the mother’s abdomen. This scan is like a routine pregnancy ultrasound, except that it is entirely focused on the baby’s heart. 
• Transthoracic echo is the most common type of echocardiography and is non-invasive, as the ultrasound probe is placed on your child’s chest, belly, and neck. 
• Transesophageal echo is more invasive, as a longer ultrasound probe (about the width of a crayon) is passed through the mouth, down the esophagus, and into the stomach. This is done while your child is under general anesthesia, usually as part of a heart surgery or to help plan or guide a cardiac catheterization procedure.  
• Intracardiac echo is performed as part of a minimally invasive catheterization procedure while your child is asleep under general anesthesia. Through a tiny incision in a vein in your child’s leg, a thin and flexible ultrasound probe is threaded through blood vessels to capture highly detailed images from inside the heart. This is often used during procedures that repair atrial septal defects.  
• Epicardial echo captures highly detailed images of the heart while the chest is open during surgery or in the pediatric cardiac intensive care unit, while your child is asleep under general anesthesia. The ultrasound probe is covered with a sterile sleeve and placed gently on the heart to show heart structures that can’t be seen any other way. 

Advanced Functional Analysis
These specialized imaging approaches help doctors understand how your child’s heart beats and how its chambers squeeze and work together. Compared with traditional echocardiography, these techniques are more advanced, require more expertise and experience to understand and apply, and are only available at high-quality centers like Duke. 

• 3D echo is often used to evaluate left ventricular function but can also evaluate right ventricular function and complex cardiac anatomy in more detail than 2D imaging alone. Using a specialized ultrasound probe, the entire left or right ventricle -- the bottom chambers of the heart -- is examined.
• Speckle-tracking imaging shows the motion of different parts of the heart as they move. This can identify when segments of the heart are moving at different times, and it can help detect problems early after heart transplantation or chemotherapy treatment.
• Dyssynchrony imaging, a form of speckle-tracking imaging, examines timing or patterns of uncoordinated (or out of sync) contractions in the heart. This helps determine whether a certain type of pacemaker could be beneficial.
• Blood speckle imaging tracks blood flow in three dimensions and shows when it is disturbed. 

Cardiac CT and CTA 
Cardiac computer tomography (CT) technology uses advanced X-rays to create 3D and 4D images of your child’s heart. Cardiac CT angiography (CTA) uses a special dye called contrast given through an IV, which helps doctors see the inside of the heart and blood vessels. For this test, your child will need to lie flat and be still for about 10 minutes. We offer sedation and anesthesia options to help your child stay calm and comfortable during the scan. 

Cardiac MRI and MRA
Cardiac magnetic resonance imaging (MRI) uses magnets and radio waves to capture detailed images of your child’s heart structure and function. Cardiac MRI is similar to a cardiac CT scan but can better assess heart size, heart function, blood flow, and heart muscle health. In cardiac magnetic resonance angiography (MRA), contrast given via an IV helps enhance the images and highlight blood vessels. This test takes about 60 to 90 minutes, during which your child needs to to lie still and hold their breath on command for short intervals. In most cases, parents or caregivers can be in the scan room with their child. We offer medications to help your child stay calm and relaxed during the scan, including general anesthesia for young children and for those who may have trouble following instructions. 

Cardiac Stress Imaging
A stress echo or stress MRI records images of the heart during activity rather than at rest. These tests help identify problems with the heart’s valves, blood flow, or oxygenation. It can also determine if the heart is abnormally thick. 

• During a stress echo, your child undergoes a regular transthoracic echo at rest, and then again immediately after running on a treadmill or riding an exercise bike.  
• During a stress MRI, your child receives an IV medication for about two minutes that increases their heart rate to simulate exercise. The medication’s effects wear off within 30 seconds. MRI contrast is administered through a second IV. This test can help identify problems with blood flow to different parts of the heart. 

Experts use a combination of ultrasound, CT, and MRI images to create a life-sized, 3D-printed model of your child’s heart. This innovation allows surgeons and cardiologists to inspect and understand your child’s heart like never before -- without an invasive procedure -- and plan surgeries and interventions with incredible accuracy. 

History of Innovation
Duke cardiologists and engineers helped invent the technology that is used in modern echocardiography, 3D echocardiography, and cardiac MRI scanning. We continue to be leaders in developing new techniques and methods to improve image clarity, better understand cardiac structure and function, and reduce radiation exposure. 

Meeting the Highest Standards for National Accreditation
Duke’s pediatric echocardiography program was one of the first in the nation to be accredited by the Intersocietal Accreditation Commission (IAC) -- a nonprofit organization that recognizes high-quality imaging services -- and has been continuously accredited for more than 20 years. Duke was recently honored with the IAC's Bronze Accreditation Milestone Award for our longstanding commitment to improving echo quality, patient outcomes, and patient safety. 

More Sedation Options
We understand that it can be difficult for children to stay still during cardiac imaging. We offer a variety of sedation options, including sedated cardiac MRI, CT, and echo scans. Our dedicated team of pediatric cardiac anesthesiologists have specialized training in administering sedation in babies and children with heart disease or prior heart surgeries. This allows us to perform more imaging studies with light sedation instead of general anesthesia, minimizing risk and reducing procedure time. 

Expert, Team Approach to Care
Our team includes cardiothoracic imaging specialists -- pediatric cardiologists who complete an additional year of training in heart imaging technique; imaging nurses; and experts in cross-sectional imaging, fetal echocardiography, and more. Our highly trained pediatric cardiac sonographers are certified in pediatric echocardiography, and many are certified in fetal echocardiography.

Advanced Equipment
We offer a specialized fetal echo machine that combines the most advanced technology for both obstetrical and cardiac imaging. Our photon-beam CT scanner helps produce the highest-resolution images of the heart available. We also offer dedicated cardiac MRI scanners in the Duke Cardiovascular Magnetic Resonance Center, whose staff has specialized expertise in cardiac MRI and who are international leaders in the cardiac MRI field. 

Active Participation in Leading Groups
Our providers participate in and help lead professional organizations like the Society for Cardiovascular Magnetic Resonance, American Society of Echocardiography, American College of Cardiology, American Heart Association, Society of Pediatric Echocardiography, and Fetal Heart Society. This keeps us up to date on emerging research and new imaging techniques.

Family-Centered Care
We prioritize the wellbeing of your child as well as your family throughout your time at Duke. For example, trained child life specialists help your child understand and feel comfortable during imaging tests. Our pediatric radiologists are part of the Image Gently Alliance, which is dedicated to limiting radiation exposure during X-rays and CT scans. And our neonatal bonding program relies on our fetal cardiac imaging expertise to determine when it’s safe for newborns with congenital heart problems to stay with their parents right after birth. We always balance clinical recommendations with what’s best for your child overall.