New Techniques for Echocardiographic Evaluation of Cardiac Anatomy in Congenital Heart Disease

Abstract

The outlook for infants born with serious forms of congenital heart disease has recently been significantly improved by better diagnostic, medical and surgical management techniques for congenital cardiovascular disorders. The applications of deep hypothermia, profound cold cardiac arrest, and other changes in surgical management have improved surgical mortality and outlined the necessity for accurate pre-surgical diagnosis. Nonetheless, the known risks of cardiac catheterization in infants and children which exceed those in adults, have increased the importance of non-invasive techniques, which have, therefore, had a major impact in pediatric cardiology (1, 2). The recent development of cross-sectional echocardiography and its ability to define spatial cardiac relationships, even in complex clinical conditions (3–9), has increased the applicability of ultrasound techniques in pediatric cardiology. The development and application of new views of cross-sectional echocardiography have widened the scope of the anatomy which can be evaluated non-invasively. It will be the purpose of this paper to review applicability of sequential linear array scanning systems, and sector scanners, in cross-sectional echocardiographic evaluation of cardiac anatomy, using a flow-oriented approach. This approach appears capable of defining systemic venous and abdominal relationships, pulmonary venous relationships, atrial and ventricular relationships, and the relationships of the distal outflow tracts, to completely define cardiac situs, ventricular orientation, great vessel orientation and the status of the distal outflow tracts in infants with congenital heart disease.