ACC/AHA/ASE/HRS/ISACHD/SCAI/SCCT/SCMR/SOPE 2020 Appropriate Use Criteria for Multimodality Imaging During the Follow-Up Care of Patients With Congenital Heart Disease

The American College of Cardiology ( ACC) collaborated with the American Heart Association, American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and the Society of Pediatric Echocardiography to develop Appropriate Use Criteria ( AUC) for multimodality imaging during the follow- up care of patients with congenital heart disease (CHD). This is the first AUC to address cardiac imaging in adult and pediatric patients with established CHD. A number of common patient scenarios ( also termed indications) and associated assumptions and definitions were developed using guidelines, clinical trial data, and expert opinion in the field of CHD ( 1). The indications relate primarily to evaluation before and after cardiac Indications related to surveillance are based on a patient's symptoms and the hemodynamic significance of cardiac lesions. Unrepaired VSD with ES is addressed in Table 6 (PH Associated With CHD). In the postprocedural section, evaluation due to change in clinical status and/or new concerning signs or symptoms includes complications such as significant residual shunt, device migration, thrombosis or erosion, valvular lesions, ventricular dysfunction, development of double-chambered RV or subaortic membrane, arrhythmias, and PH. Scenarios related to surveillance imaging of small muscular VSDs (indications 20 to 22) and those following complete repair without sequelae (indications 31 to 33) do not address duration of follow-up. This does not imply indefinite follow-up in such cases, and clinicians should base this decision on available guidelines.