Three-dimensional echocardiography in adult congenital heart disease

Abstract

Due to the success of cardiac surgery in infancy and childhood, starting some 40 years ago and improving ever since, the survival for patients with congenital heart disease has improved dramatically. Over 85% of all patients born with a congenital cardiac defect now survive beyond childhood, often well into adult life. Many of these patients have residual abnormalities, which may be morphological, functional or (most often) both, and these residua tend to change with time. As an example, the patient with repaired tetralogy of Fallot will require long-term monitoring of problems such as pulmonary regurgitation with consequent volume loading of the right ventricle, ventricular dysfunction, and associated arrhythmias. Patients with repaired coarctation will require monitoring of associated lesions, such as bicuspid aortic valve, aortic valve stenosis/regurgitation, recurrent aortic arch obstruction, and systemic arterial blood pressure. The result is that the vast majority of patients, who had their congenital cardiac malformation “repaired” or “corrected” at a young age, require follow-up throughout childhood and adult life. Imaging plays a major role in this follow-up. In current clinical practice, more than 90% of the imaging involves echocardiography.