Two-dimensional echocardiographic features of interruption of the aortic arch

The 2-dimensional echocardiographic features of interruption of the aortic arch are presented based on analysis of the echocardiograms and angiograms from 8 infants: 2 with type A and 6 with type B interruption. Each infant had a patent ductus arteriosus, 6 had a conoventricular septal defect with leftward deviation of the conal septum, 1 had truncus arteriosus with truncal valve stenosis, and 1 had a distal aortopulmonary septal defect with an intact ventricular septum. Echocardiographic images obtained from the suprasternal notch or from a high parasternal approach demonstrated the interruption of the aortic arch and continuation of the patent ductus arteriosus into the descending aorta. These findings were compared with those in infants with aortic atresia and a hypoplastic ascending aorta or discrete coarctation of the aorta with tubular hypoplasia of the aortic arch. Types A and B interruption of the aortic arch were easily differentiated and the caliber of the patent ductus arteriosus was assessed. The characteristic conoventricular septal defect was readily visualized from an apex 2-chamber view or from a subcostal sagittal plane view. With this information subsequent angiography can be more expeditiously performed in this group of critically ill infants.     

A neonate with mitral stenosis due to accessory mitral valve,ventricular septal defect,and patent ductus arteriosus: changes in echocardiographical findings during the neonatal period

 A female neonate with mitral stenosis due to accessory mitral valve with ventricular septal defect and patent ductus arteriosus is described. She was referred to our hospital because of neonatal asphyxia. Asphyxia was improved by ventilator support, but rapid deterioration of respiration with pulmonary congestion and hemorrhage appeared 8 days after birth. Echocardiography revealed an accessory mitral valve attached to the anterior mitral leaflet with a perimembranous ventricular septal defect and patent ductus arteriosus. Although there were no echocardiographical findings indicating mitral stenosis on admission, the mitral stenosis blood flow patterns were detected by color and pulsed Doppler examination performed on the eighth day after admission. Transaortic resection of accessory mitral valve tissue was performed with patch closure of the ventricular septal defect and ligation of the ductus arteriosus 35 days after birth. After operation, pulmonary congestion and hemorrhage were improved. Postoperative echocardiography showed complete resection of the accessory mitral valve and no mitral insufficiency. We concluded that the combination of the accessory mitral valve and left-to-right shunt due to ventricular septal defect or patent ducturs arteriosus might have led to a critical hemodynamic condition due to relative mitral stenosis in the neonatal period with the decrease in pulmonary vascular resistance. Received: May 30, 2002 / Accepted: September 6, 2002 Correspondence to T. Ito     

室间隔缺损并发畸形的发生率和超声心动图检测的漏诊分析

目的 :探讨室间隔缺损并发畸形的发生率及超声心动图漏检并发畸形的原因。方法 :对 379例非复杂性先心病室缺并发畸形的超声心动图检测结果与手术所见进行比较。结果 :较常见的非复杂性先心病室缺并发畸形的发生率为 36.0 % ,为卵圆形未闭、房缺、动脉导管未闭、右室流出道狭窄、右室双腔心及肺动脉瓣狭窄。超声心动图比较容易漏诊的室缺并发畸形为卵圆孔未闭、右室流出道狭窄及一些少见并发畸形。结论 :彩色多普勒超声心动图对室缺并发畸形具有一定的漏诊率 ,注意全面扫查及改进探查技巧有助于提高室缺并发畸形的检出     

Hypoplastic left heart syndrome: is echocardiography accurate enough to guide surgical palliation?

Two-dimensional echocardiography can diagnose hypoplastic left heart syndrome. However, with the advent of the possibility of palliative open heart surgery, complete anatomic diagnosis is necessary. The anatomic findings of 15 neonates with hypoplastic left heart syndrome (age 1 to 10 days, mean 4.1) who had two-dimensional Doppler echocardiographic studies were compared with the results obtained by angiography (6 cases), surgery (11 cases) and autopsy (8 cases). Complete two-dimensional echocardiographic examination of the aortic arch, pulmonary and systemic venous return, atrial septum, ductus arteriosus and proximal coronary arteries was possible in all 15 neonates and correctly diagnosed hypoplastic left heart syndrome in each. Anatomic two-dimensional echocardiographic assessment was accurate in 13 (86%) of the 15 neonates and there were no false positive results. Undiagnosed associated abnormalities were hypoplasia of a left pulmonary artery in one patient and left superior vena cava in another. Accurate quantitation of the size of the tricuspid valve anulus, ascending aorta, pulmonary anulus and right and left pulmonary arteries was possible. Doppler examination was performed in seven patients and confirmed retrograde aortic arch flow and right to left systolic shunting in the patent ductus arteriosus. In selected neonates, surgical palliation can be attempted without angiography.     

Absent pulmonary valve or pulmonary atresia with intact ventricular septum: Which is it?

A fetal echocardiogram noted valvar pulmonary atresia vs critical pulmonary valve stenosis, confluent pulmonary arteries, patent ductus arteriosus, and an apical muscular ventricular septal defect vs coronary sinusoid. Postnatal echocardiogram documented an absent pulmonary valve, coronary artery fistula to the right ventricle, confluent pulmonary arteries, and a patent ductus arteriosus. Catheterization confirmed the postnatal echocardiographic findings except there was no antegrade flow from the right ventricle to the pulmonary arteries. Close evaluation of all imaging modalities revealed the final diagnosis of absent pulmonary valve with a double-chambered right ventricle with no egress from the right ventricle to pulmonary artery.     

房间隔缺损并发畸形的介入治疗

目的 :评价同期应用介入治疗房间隔缺损 （ASD）及其并发心脏其它畸形的可行性和治疗效果。方法 :全组 7例 ,年龄 2～ 6 5 （34± 2 8）岁。经临床、心电图、X线及超声心动图诊断为 ASD并发其他心脏畸形 ,其中 3例为肺动脉瓣狭窄 ,2例为二尖瓣狭窄 （L utembacher综合征 ） ,2例为动脉导管未闭 （PDA ）。应用 Amplatzer封堵器经导管关闭ASD前 ,先纠正其它畸形 （包括瓣膜成形术及 PDA封堵术 ）。术后 3d,1～ 6月分别行经胸超声心动图 （TTE）、心电图、X线检查评价治疗效果。结果 :7例同期介入治疗均获得成功 ,术中未发生任何重要并发症。术后 3d,1～ 6月TTE显示房间隔无残余分流。并发肺动脉瓣狭窄患者 ,术后即刻跨肺动脉瓣压差得到满意的下降 ;L utembacher综合征患者 ,二尖瓣瓣口面积分别由术前 1.0 ,1.2 cm2增加到术后 1.9,2 .0 cm2 ,左房平均压分别由 2 9,2 6 m m Hg（1mm Hg=0 .133k Pa）降至 8,7m m Hg;并发 PDA患者 ,应用 Amplatzer封堵器 PDA关闭术后 10 min降主动脉侧位造影 ,无残余分流。术后 6月 X线检查显示肺血减少 ,心脏房、室缩小。结论 :同期介入治疗 ASD并发某些心脏畸形是一种有效、安全、简便可行的方法。     

Two-dimensional echocardiographic prospective diagnosis of common truncus arteriosus in infants

Two-dimensional echocardiographic prospective diagnosis of truncus arteriosus was made in 7 infants. Two infants had truncus arteriosus type I, 3 patients had truncus arteriosus type II, 1 infant had truncal valve stenosis with an interrupted aortic arch, and 1 had type IV truncus arteriosus with pulmonary hypertension. Multiple imaging views were utilized to confirm the diagnosis. The parasternal long-axis view demonstrated the great vessel-ventricular septal override and the origin of the pulmonary arteries from the posterior aspect of the ascending truncus. The suprasternal notch image facilitated identification of the left- or right-sided aortic arch and the origin of the pulmonary arteries from the truncus. Transverse imaging sections at the base of the heart facilitated identification of the pulmonary artery origin of truncus arteriosus type I. Subcostal coronal and sagittal views imaged the common truncus and the ventricular septal defect.

These echocardiographic images were contrasted with and discriminated from those of an infant with aorticopulmonary window with intact ventricular septum. Although cardiac catheterization and angiography may be required to assess pulmonary arterial pressure, pulmonary vascular resistance, and the distal pulmonary arterial anatomy in truncus arteriosus, 2-dimensional echocardiography can be used to correctly establish the morphologic diagnosis of truncus arteriosus in infants.     

Echokardiographische Diagnostik angeborener Herzfehler im Erwachsenenalter

Echo and Doppler echocardiographic procedures have gained special importance in the diagnostics of congenital diseases in adults. These procedures permit detailed visualization of the pathomorphology of the heart as well as reliable evaluation of the hemodynamic changes. There are differentiated indications for the various procedures, such as transthoracic and transesophageal echocardiography, Doppler and color-Doppler echocardiography, contrast echocardiography and 3-dimensional echocardiography. This article discusses the opposition of the various echo and Doppler echocardiographic procedures with respect to the diagnostics of the most frequent non-operated congenital diseases in adults. The pathomorphology of the various congenital diseases will be summarized and then the important echocardiographic criteria presented which are decisive for the diagnostic procedure. In simple congenital malformation of cardiac valves, such as bicuspid aortic valve (Figure 1: aortic ring abscess), pulmonary valve stenosis (Figure 2), Ebstein's anomaly (Figure 3) or malformations of the mitral valve (Figure 4: cleft in the anterior mitral cusp), the diagnosis can often be made using transthoracic echo and Doppler echocardiography, and the severity of the defect determined. However, the sonographic conditions, especially in adults, are frequently too limited to permit recognition of detailed smaller changes, so that transesophageal examination is required to finally confirm the diagnosis in these patients. In the diagnostics of diseases of the left ventricular outflow tract and the thoracic aorta, such as subvalvular aortic valve stenosis (Figure 5), the sinus of Valsalva aneurysm or the coarctation of the aorta (Figure 6), the left ventricular outflow tract can be evaluated morphologically from a transthoracic procedure and the accelerations of flow can be recorded by continuous wave Doppler. If there is no sclerosis of the fibrous membrane, these can often not be depicted by transthoracic procedures, so that a supplementary transesophageal examination is meaningful. This is required in any case for diseases of the descending thoracic aorta. In the case of congenital lesions, such as atrial septal defects (Figure 7: anomalous pulmonary venous return, Figure 8: 3-dimensional visualization of an atrial septal defect, Figure 9: sinus venosus defect), ventricular septal defect or a patent ductus arteriosus Botalli (Figure 10), color-Doppler and contrast echocardiography have become especially important. Transesophageal examination is also indicated for these congenital diseases for direct depiction of the defect as well as for precise evaluation of the shunt. Moreover, in atrial septal defects, it has been shown that a 3-dimensional echocardiography provides additional advantage with respect to spatial relationship of the defect to the other cardiac structures, as well as presenting dynamic changes during a heart cycle. Extensive knowledge of complex congenital heart disease, such as tetralogy of Fallot (Figure 11), complete transposition of the great arteries, congenitally corrected transposition of the great arteries (Figure 12), the double-outlet right ventricle, truncus arteriosus communis, the cor triatriatum, tricuspid atresia (Figure 13) or the univentricular heart (Figure 14) usually requires performance of a transthoracic echo- and Doppler echocardiographic examination to assess the pathomorphological changes and to examine hemodynamics. In the majority of patients, supplementary transesophageal echocardiography and an echo contrast examination are important. Initial examinations using 3-dimensional echocardiography are very promising in this connection and with respect to the exact spatial presentation of pathoanatomical structures.     

Echocardiographic evaluation of total anomalous pulmonary venous connection: Comparison of obstructed and unobstructed type

This study aims to compare the differences between obstructed and unobstructed total anomalous pulmonary venous connection (TAPVC) using echocardiography, and to evaluate the clinical and echocardiographic parameters associated with pulmonary venous obstruction (PVO).We conducted a retrospective study of 70 patients with TAPVC between 2014 and 2019. The morphologic and hemodynamic echocardiographic parameters of patients were observed and measured, and the parameters between obstructed and unobstructed TAPVC were compared. The clinical and echocardiographic parameter differences between the two groups were used for ROC curve analysis.Obstructed TAPVC was found in 30 (42.9%) of 70 patients. Between obstructed and unobstructed TAPVC, there were significant differences in atrial septal defect size, pulmonary artery maximum velocity (PA V_max ), peak E velocity of mitral valve, left ventricular fractional shortening, left ventricular ejection fraction, stroke volume and the incidence of patent ductus arteriosus, but there was no significant difference in birth weight. The first diagnosis age of obstructed TAPVC was earlier than unobstructed type. The ROC curve analysis for the first diagnosis age showed the sensitivity and specificity were 76.7%, 80% respectively. The ROC curve analysis for the PA V_max showed the sensitivity and specificity were 88.5%, 67.6% respectively.Patients with TAPVC had a high incidence of PVO. The presence of PVO can affect the size of atrial septal defect and the closure of the ductus arteriosus, cause significant changes in PA V_max, peak E velocity of mitral valve, left ventricular fractional shortening, left ventricular ejection fraction, stroke volume, lead to earlier symptoms and earlier first diagnosis age. The first diagnosis age and PA V_max were excellent values since they associated with PVO.     

Surgery without catheterization for congenital heart defects: management of 100 patients

Little information is available regarding the surgical mortality of children with congenital heart disease who undergo operation on the basis of clinical assessment and echocardiographic diagnosis without cardiac catheterization. If catheterization affects early surgical mortality then perhaps omitting it would improve survival. Early operative mortality of 100 patients managed with echocardiography without preoperative catheterization (Group I) was compared with that of 151 diagnosis-matched control patients who had catheterization (Group II). The catheterization (Group II) and echocardiographic (Group I) groups included patients with the following diagnoses: atrial septal defect (33 and 17 in Group II and Group I, respectively); pulmonary stenosis/pulmonary atresia (33 and 15), aortic stenosis (14 and 3), coarctation of aorta (36 and 29), patent ductus arteriosus (10 and 15) and miscellaneous (25 and 21). Age range was 1 day to 16 years (mean 3.5); 114 (45%) of the 251 patients were less than 1 year of age and 59 (29%) were less than 1 month of age. With one exception, echocardiographic diagnosis was correct when compared with findings at surgery or autopsy, or both. Surgical mortality was 18% in Group I and 9% in Group II; however, multiple logistic regression analysis adjusting for differences in age and preoperative condition showed no significant difference between the two groups with a trend toward lower mortality in Group I (p = 0.075). Echocardiography as the definitive imaging modality in selected patients with congenital heart disease is accurate and is comparable with conventional methods of preoperative diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Echocardiographic aspects of persistence of the right valve of the venous sinus

The aim of this work is to demonstrate the possibility to identify persistent right sinus venous valve and to differentiate it from other right sided heart pathology by two dimensional echocardiography. We report the echocardiographic findings observed in three out of 215 paediatric patients we examined for clinically suspected congenital heart disease in 12 months period. The first patient was a 24 hours old newborn with transient pulmonary hypertension; the second one was a 6 months old child with pulmonary atresia, severe right ventricular hypertrophy, atrial septal defect and patent ductus arteriosus; the third patient, aged 6 months, had atrial septal defect and mild pulmonary stenosis. In all three patients a particular linear structure was seen, as a membrane that crossed the right atrium from the orifice of the inferior vena cava towards the atrial septum. This structure was identified as persistent right sinus venosus valve according to its morphology, its position into the right atrium and its connection to the atrial septum. The incidence of this echocardiographic finding was 1.4% in our series. In the first case contrast echocardiography from the inferior vena cava demonstrated the deviation of blood flow caused by the persistent sinus valve, although no intra-atrial pressure gradient was shown at cardiac catheterization. In the second patient who died during the operative procedure for making a systemic-pulmonary anastomosis, post mortem examination showed a membranous structure connecting the orifice of the inferior vena cava to the atrial septum.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prevalence of additional cardiovascular anomalies in patients referred for transcatheter closure of patent ductus arteriosus

Catheter closure of the patent ductus arteriosus is now a reality. The purpose of this study was to establish the prevalence of associated cardiovascular defects and the accuracy of echocardiography in patients referred for transvenous ductal closure. This study reviewed 146 patients seen from 1981 to 1988: 126 with only a patent ductus arteriosus (Group I) and 20 with additional cardiovascular anomalies (Group II). Groups I and II did not differ significantly in age, gender or physical examination except for the presence of a continuous murmur (Group I 100% versus Group II 80%, p less than 0.001). A left patent ductus arteriosus was visualized by two-dimensional echocardiography in 96% of patients and was evident by Doppler study in 100%. A patent ductus arteriosus was not seen in six patients including a patient who was found to have only a collateral network from the aorta to the main pulmonary artery. The 12 patients with noncardiovascular abnormalities such as Down's syndrome were more likely than the overall group to have additional cardiovascular anomalies (6 of 12, p = 0.001). The cardiovascular anomalies encountered were varied. Eight of the 20 patients with such anomalies had only a restrictive ventricular septal defect in addition to the patent ductus arteriosus. Significant anomalies found at catheterization included two thoracic arteriovenous malformations and an isolated right carotid artery draining into the right pulmonary artery by way of a right ductus arteriosus. This study indicates that echocardiography is an effective diagnostic technique in this patient group. A thorough cardiac catheterization with angiography should be performed before implantation of a ductal device.     

Assessment of the ductus arteriosus in preterm infants utilizing suprasternal two-dimensional/Doppler echocardiography

Evaluation for patent ductus arteriosus by both Doppler examination and direct two-dimensional echocardiographic visualization has been reported in infants and children. However, visualization of a patent ductus arteriosus in preterm infants with lung disease has been difficult. Using a recently developed 7.5 MHz mechanical scanner with interfaced two-dimensional directed pulsed Doppler ultrasonography, 36 examinations were performed from a suprasternal approach in 27 patients (age range 1 day to 3 months, mean 18 days; weight range 490 to 2,500 g, mean 1,260). Complete imaging for evaluation of patency of the ductus arteriosus was successful in 33 (92%) of 36 examinations, and imaging of the pulmonary end of the ductus arteriosus was successful in all. In 18 examinations, the ductus arteriosus was closed by both two-dimensional echocardiography and Doppler examination. In four cases the ductus arteriosus was widely patent by both two-dimensional echocardiography and Doppler examination. Eleven echocardiographic examinations revealed a narrowed ductus arteriosus, and of these, 10 (91%) showed Doppler findings of patent ductus arteriosus. It is concluded that combined two-dimensional/Doppler echocardiographic assessment allows confident detection of both a large unrestrictive and a small, stenotic patent ductus arteriosus in preterm infants with lung disease.     

Echocardiographic evaluation of the spectrum of cardiac anomalies associated with trisomy 13 and trisomy 18

To investigate the role that cardiac anomalies play in the early death frequently seen in the trisomy 13 and the trisomy 18 syndromes, two-dimensional and Doppler echocardiograms from 31 newborn infants with cytogenetic confirmation of these syndromes seen at one institution over a 4.5 year period (1983 to 1988) were reviewed. The mean age at echocardiography was 1.5 days, and the median age at death was 14 days. Significant cyanosis was present in 58%. Cardiac anomalies that would be considered lethal within the neonatal period were present in only 19% of patients. The most common lesions were atrial septal defect (81%), ventricular septal defect (61%) and patent ductus arteriosus (85%). Most ventricular septal defects and patent ductus arteriosus were large. Valvular dysplasia of one or more valves, graded as mild in most cases, was found in 68%, but was not associated with Doppler evidence of significant regurgitation or stenosis in any subject. Of the four valves, the pulmonary valve, followed by the tricuspid valve, was the most commonly dysplastic. Doppler evidence suggestive of elevated pulmonary artery pressure (low velocity bidirectional flow across the ventricular septal defect and patent ductus arteriosus), although expected, was accompanied by greater than normal mean right ventricular cavity and free wall dimensions in these patients. Thus, although the cardiac anomalies most frequently encountered in trisomy 13 and trisomy 18 are nonlethal, the combined findings of frequent cyanosis and increased right ventricular dimensions suggest that other factors such as pulmonary hypertension, perhaps related to maldevelopment of the pulmonary vasculature, may contribute to early death in some of these infants.     

Impact of two-dimensional and Doppler echocardiography on care of children aged two years and younger

To determine the impact of 2-dimensional (2-D) and Doppler echocardiography on the care of children aged 2 years and younger with suspected cardiac disease, the clinical management and outcome for the years 1975 (pre-2-D/Doppler era, 161 patients) and 1985 (2-D/Doppler era, 206 patients) were compared. Differences were: (1) decreased catheterization at our institution (48% vs 21%, p less than 0.0001); (2) trend toward decreased recatheterization of patients with referral catheterization (62% vs 38%, p = 0.08); (3) increased operation without preoperative catheterization (10% vs 37%, p less than 0.001); and (4) decreased preoperative catheterization for 7 anomalies (patent ductus arteriosus, ventricular septal defect, atrial septal defect, atrioventricular canal, aortic stenosis, tetralogy of Fallot and complete transposition of great arteries). Operative mortality rates were not statistically different in the years compared. Also, the operative mortality rates in 1985 for patients with and without preoperative catheterization were not statistically different. In 1975, cardiac catheterization changed the primary clinical diagnosis in 21%. In 1985, the primary diagnosis was not changed by catheterization; however, 2-D and Doppler echocardiography changed the diagnosis in 18%. The change in utilization of cardiac catheterization appears to be most closely related to the maximal utilization of a substitute imaging and hemodynamic modality--namely, 2-D and Doppler echocardiography.     

彩色多普勒超声在诊断主动脉窦瘤破裂中的应用

目的:探讨经胸及经食道彩色多普勒超声心动图在诊断主动脉窦瘤破裂的应用价值。方法:用彩色多普勒超声心动图检查有级以上心脏杂音,诊断为主动脉窦瘤破裂合并室间隔缺损(VSD)及主动脉瓣关闭不全的患者,共16例。结果:16例主动脉窦瘤破裂患者中,右冠窦瘤破裂13例,无冠窦瘤破裂3例,合并室间隔缺损9例,合并主动脉瓣脱垂3例,合并肺动脉瓣狭窄及动脉导管未闭各1例。结论:彩色多普勒超声心动图可以直观地显示主动脉窦瘤的有无及其破裂口的大小和数目,还可以对主动脉窦瘤破裂合并心脏畸形的类型作出诊断,很有意义。     

Clinical analysis of 15,089 operations on the heart and great vessels: results from the People's Republic of China

Over a 28-year period, from November 1957 through November 1985, 15,089 patients underwent operations on the heart and great vessels at The Shanghai Chest Hospital. Herein we examine this experience, with particular attention to factors that affected mortality. Seven thousand two hundred eighty-one patients underwent procedures for mitral stenosis; 149 (2.0%) of these died. Two thousand one hundred thirty-three patients underwent closure of a patent ductus arteriosus; this procedure was associated with 9 deaths (0.4%), 5 of which were caused by massive hemorrhage. After 1964, over 98% of the procedures were accomplished with a locally-manufactured surgical stapler. This device allowed us to perform without any deaths a consecutive series of 1,838 patent ductus arteriosus closures from January 1970 to the end of our study. One thousand five hundred twnety-one patients underwent repair of a ventricular septal defect; 60 died, for a mortality rate of 3.9%. One thousand four hundred thirty-five patients had repair of an atrial septal defect; 13 died during or after operation, for a mortality rate of 0.9%. Higher mortality was observed in groups with severe pulmonary hypertension. Six hundred fifty-one patients were treated for pulmonary stenosis; 24 died, for an operative mortality of 3.7%. Five hundred eighty-five patients underwent total correction of tetralogy of Fallot; 100 died, for a mortality rate of 17.1%. Two hundred forty-seven patients with constrictive pericarditis underwent 250 pericardiectomies; 17 (6.9%) died during or after operation. Two hundred one patients had mitral or aortic valve insufficiency, or both. These patients underwent mitral, aortic, or double valve replacement; 30 died (14.9% mortality). One hundred eleven patients underwent aortic aneurysm resection; 24 died, for an operative mortality of 21.6%. This is 1 of the largest cardiovascular series ever reported from the People's Republic of China; therefore, it is a useful data base for study of cardiovascular surgical procedures and their results over a 3-decade period.     

Contrast echocardiography during cardiac catheterization in patients with congenital heart diseases

Contrast echocardiography performed during cardiac catheterization has mostly been limited to a few published case reports. We studied 37 patients with congenital heart disease to assess the capability of the method to diagnose cardiac shunts and valve regurgitation. Injections of 5% dextrose in water through an angiographic catheter were made to evaluate septal integrity and valve competence compared with conventional contrast angiography. An overall sensitivity of 93% and specificity of 78% were found. In four cases of atrial septal defect and seven of mitral regurgitation, the sensitivity was 100%. It was slightly lower for eleven cases of ventricular septal defect (91%) and four of patent ductus arteriosus (75%). When assessing aortic, tricuspid and pulmonary valve competence, the method proved to be more sensitive than conventional angiography to detect mild regurgitation. Contrast echocardiography is a sensitive and safe technique that may be used in association with conventional angiography reducing the need for radiographic contrast and ionizing radiation time. © 1993 Wiley-Liss, Inc.     

Doppler echocardiographic evaluation of left-to-right shunts in congenital heart disease

Doppler echocardiography enables the possibility of determining pulmonary to systemic flow ratios in patients with left to right shunts. Volume flow is calculated as the product of mean velocity over time, as evaluated by pulsed Doppler, and the cross-sectional area through which the flow passes. Appropriate sites for measurement of velocity and cross-sectional area of flow are the ascending aorta, right ventricular outflow tract and pulmonary artery as well as the tricuspid and mitral valve orifices. Velocity is always recorded as parallel as possible to the direction of flow. Echocardiographic measurements of the area of flow are carried out at the level of the sample volume. In the presence of an atrial or ventricular septal defect, the flow in the ascending aorta normally serves as systemic flow; alternatively, mitral or tricuspid flow may be used to cross-check these values. The latter serves for calculation of systemic flow in patent ductus arteriosus. In atrial or ventricular septal defect, the pulmonary flow is normally derived in the region of the pulmonary artery; in patent ductus arteriosus, however, in the region of the ascending aorta. As an alternative, or for confirmative use, in atrial septal defect the tricuspid flow and in ventricular septal defect and patent ductus arteriosus the mitral flow, can be taken into consideration. Studies we performed in 31 patients with atrial septal defect showed a close correlation between Doppler echocardiographic measurements and data obtained by cardiac catheterization and radionuclide studies.(ABSTRACT TRUNCATED AT 250 WORDS)     

Endovascular intervention in the treatment of congenital heart disease in adults

Over the last years, endovascular intervention have become an important part of treatment in patients with congenital heart disease particularly for residual defects after surgery done in infancy. These transcatheter procedures can be described as dilatation of stenotic sites (angioplasty, endovascular stenting and valvuloplasty) or as a closure of anomalous openings (device closure defects and vascular embolisation). Balloon valvuloplasty, without or with stent, is the procedure of choice in adults with pulmonary valve stenosis, pulmonary arteries stenosis, bicuspid aortic valve stenosis without calcification, aortic re-coarctation. Treatment of native aortic coarctation is still under debate. Devices for closing atrial and ventricular septal defects or patent ductus arteriosus have been developed and are now widely used. Transcatheter, plug or coil occlusion is nowadays the goal treatment in a wide range of arterial and venous vascular connections. This review describes the current role of each major catheter-directed therapy in the treatment of congenital heart disease in adults.