View source for Segmental echocardiographic approach to congenital heart disease

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



==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

* ''[[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==
[http://www.med.yale.edu/intmed/cardio/chd/contents/index.html Yale Echo in Congenital Heart Disease]

==Reference==
* Feigenbaum's Echocardiography 6th Ed.



[[Category:Cardiology]]

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