Echo in congenital heart disease

Editors: Eli V. Gelfand, MD and Keri Shafer, MD (Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA)

Echocardiographic evaluation of congenital heart disease requires segmental and systematic approach.

• 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

• Situs inversus is mirror image (morphologic right atrium is to the left, left atrium to the right)

• 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.

• Evaluate morphologic atrium and ventricular connection.
• Must assess ventricular morphology to confirm

• 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

• 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

Yale Echo in Congenital Heart Disease

• Feigenbaum’s Echocardiography 6th Ed.

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Editors-in-Chief: Eli V. Gelfand, MD and Keri Shafer, MD (Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA)

A ventricular septal defect (or VSD) is a defect in the ventricular septum (the wall dividing the left and right ventricles of the heart). The ventricular septum consists of a muscular (inferior) and membranous portion (superior). The membranous portion (which is close to the atrioventricular node) is most commonly affected.[1]

Congenital VSDs are collectively the most common congenital heart defect.[2]

• location and number of defects
• direction of shunting
• PA and RV pressures
• LV thickness, presence of hypertrophy/overload
• associated anomalies

Size of the defect determines on the plane in which it is visualized as the defect is usually not symmetric. MUST take maximum diameter.

• best seen on parasternal long, short or 5 chamber views

Yale University School of Medicine Congenital Heart Disease: Membranous VSD

• best seen on apical 4 chamber view

unusual VSD:

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• best seen on parasternal long/short views

Trabecular defects are best seen on parasternal long and apical 4 chamber views

Yale Congenital Heart Disease- VSD

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Editors-in-Chief: Eli V. Gelfand, MD and Keri Shafer, MD (Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA)

Echocardiogram done in TGA to evaluate:

• atrioventricular connections
• atrial morphology: determined by venous return and atrial appendage morphology
• ventricular morphology:
  • determined by presence of moderator band (right ventricle), trabeculi, valvular morphology, etc.
  • seen best in subcostal, parasternal short axis and apical 4 chamber views
• presence of outflow obstruction

Though transthoracic echo can provide valuable information, in adults a transesophageal echo (TEE) is usually necessary. Typically, MRI is performed as well.

Consists of two basic types:

• D-TGA
• L-TGA otherwise known as congenitally-corrected TGA

Image obtained from: [1]

Echo series of ccTGA:

LA-RV RA-LV connections

RV-aorta LV-PA connections

For more information please go to Transposition of the great vessels.

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