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The first Appropriate Use Criteria (AUC) on follow-up imaging in patients with established congenital heart disease (CHD) was released by the American College of Cardiology and other medical societies.

Various cardiac imaging modalities were rated on their appropriateness for use in the lifelong monitoring of adults and children who already have complete diagnoses of their heart defects.

For example, transthoracic echocardiography (TTE) during routine surveillance every 3 to 5 years was rated "Appropriate" for adults with simple complexities, such as a small atrial septal defect, partial anomalous pulmonary venous connection involving a single pulmonary vein, a small ventricular septal defect, or a small patent ductus arteriosus.

TTE was also rated "Appropriate" for routine surveillance in asymptomatic patients who had undergone repair procedures for these heart defects with no or mild sequelae, among other indications in the document by Ritu Sachdeva, MBBS, of Sibley Heart Center in Atlanta, and colleagues in the .

On the other hand, TTE and transesophageal echocardiography (TEE) were both "Rarely Appropriate" for the routine surveillance of asymptomatic patients with patent foramen ovale.

"As lesion complexity increased, additional imaging modalities received higher appropriateness ratings," the authors noted.

For instance, when imaging total anomalous pulmonary venous connection either due to change in clinical status and/or new concerning signs or symptoms, TTE, cardiac MRI, and cardiac CT were all deemed "Appropriate," whereas TEE was given a "May Be Appropriate."

The reviewers consulted the and American guidelines for congenital heart disease management in deciding how to rate each indication.

"Currently, there is a dearth of clinical practice guidelines related to cardiac imaging in CHD. In the few that exist, there is a lack of guidance on frequency of imaging in the broad array of clinical scenarios faced by clinicians in their routine practice," the authors noted.

"This AUC document addresses this deficiency by including clinical scenarios from the time of diagnosis to after interventions and by providing a multimodality perspective," they continued. "With the significant advances in imaging technology and accessibility, clinicians will need to remain mindful of resource utilization and the risks versus benefits when selecting a diagnostic pathway."

As part of the Protecting Access to Medicare Act, an ordering physician must provide evidence that he or she had consulted AUC in order to bill Medicare for advanced diagnostic imaging orders.

Of note, clinical scenarios in the present set of AUC did not cover the initial TTE evaluation nor scenarios in critical care settings that may require frequent imaging.

The document was created in collaboration with the American Heart Association, the American Society of Echocardiography, the Heart Rhythm Society, the International Society for Adult Congenital Heart Disease, the Society for Cardiovascular Angiography and Interventions, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Pediatric Echocardiography.

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