Segmental, Sequential Approach to CT Interpretation in Adult Congenital Heart Disease

Abstract

The segmental, sequential, analytic approach was introduced by Van Praagh over 25 years ago [1–3]. This clinically useful approach is flexible and widely applicable to any imaging evaluation of congenital heart disease [4]. Using this logical approach, the morphologic features of the heart are determined sequentially by dividing the heart into three segments: visceroatrial situs or spatial arrangement (step 1), ventricular looping (step 2), and the spatial relationships of the great vessels (step 3). In step 4, the connections between the segments at the atrioventricular and ventriculoarterial levels are identified. Next, cardiac positioning is determined in step 5. Finally, step 6 involves the assessment for any associated malformation. See Fig. 5.1.