Segmental echocardiographic approach to congenital heart disease
You don't need to be Editor-In-Chief to add or edit content to WikiDoc. You can begin to add to or edit text on this WikiDoc page by clicking on the edit button at the top of this page. Next enter or edit the information that you would like to appear here. Once you are done editing, scroll down and click the Save page button at the bottom of the page.
Editors: Eli V. Gelfand, MD and Keri Shafer, MD (Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA)
Please Join in Editing This Page and Apply to be an Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [1] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
Evaluation of cardiac anatomy
Echocardiographic evaluation of congenital heart disease requires segmental and systematic approach.
1. Assess atrial situs
- Subcostal views are optimal
- Situs Solitus= Normal anatomy (morphologic right atrium is to the right and morphologic left atrium is to the left)
- Morphologic right atrium:
- Always contains eustachian valve
- Appendage: shorter and broader than left atrium
- Morphologic left atrium:
- Lacks eustacian valve
- Rounded shape
- Appendage: thinner, longer and narrower atrail junction compared to right atrium
- Morphologic right atrium:
- Situs inversus is mirror image (morphologic right atrium is to the left, left atrium to the right)
2. Assess venous inflow patterns
- Transverse imaging plane through abdomen
- Abdominal aorta lies to left of spine (aorta more rounded, pulsatile)
- Inferior vena cava lies to the right of spine
- Assess pulmonary inflow patterns: often difficult in the adult to identify all 4 pulmonary veins.
3. Evaluate artrioventricular connections
- Evaluate morphologic atrium and ventricular connection.
- Must assess ventricular morphology to confirm
4. Define ventricular morphology and position
- 4-chamber view for locations and valvular morphology, short axis views for papillary muscle evaluation
- Can use appearance to determine morphology of left and right ventricles:
- Right ventricle: has trabeculations
- Left ventricle: smooth endocardial surface
- Atrioventricular valves are also helpful in determining ventricular morphology:
- Tricuspid valve (right ventricle): 3 leaflets, 3 papillary muscles and chordal insertions into septum
- Mitral valve (left ventricle): 2 leaflets, 2 papillary muscles, no septal chordal insertion
5. Evaluate ventriculoarterial relationship
- Short axis views most helpful for ventricular-artery attachments, parasternal views for artery morphology, rightward aorta seen on suprasternal views.
- Normal orientation:
- Pulmonary artery: orientation is anterior and leftward
- Aorta: orientation rightward and posterior
- Two possible transposition forms
- D-transposition: normal morphologic ventricular relationship
- L-transposition: atrioventricular discordance: morphologic right ventricle on left, morphologic left ventricle on right
Back to Echo in congenital heart disease
Other links
Yale Echo in Congenital Heart Disease
Reference
- Feigenbaum's Echocardiography 6th Ed.
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
