Pathogenesis and Clinical Relevance of Diffuse Myocardial Fibrosis in Pediatric and Congenital Heart Disease

In addition to the depiction of anatomy and function, tissue characterization of the myocardium has emerged as an important asset of cardiac magnetic resonance (CMR). Among the tissue properties that are quantifiable by CMR is diffuse myocardial fibrosis. Diffuse fibrosis is regarded to be the common pathological pathway toward loss of myocardial function in many cardiac conditions, including congenital heart disease. As fibrosis seems to have a major role in myocardial failure and may be reversible, its assessment by CMR has the potential to transform the way we monitor and treat our patients. In this review, we describe the technical aspects of fibrosis quantification with CMR and outline past and potential applications in congenital and pediatric heart disease.