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. 1998 Jul;80(Suppl 1):S12–S26. doi: 10.1136/hrt.80.2008.12s

Echocardiography in adult congenital heart disease

A Houston, S Hillis, S Lilley, T Richens, L Swan
PMCID: PMC1766496  PMID: 10078071

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Figure 1  .

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M mode study from a patient with a large secundum atrial septal defect. There is marked increase in the right ventricle diastolic dimension, and paradoxical septal motion with the septum moving in parallel with the posterior left ventricular wall. RV, right ventricle; LV, left ventricle.

Figure 2  .

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Parasternal four chamber view in a patient with a large secundum atrial septal defect. There is enlargement of the right ventricle and a large gap in the central part of the atrial septum. RA, right atrium; LA, left atrium; others as before.

Figure 3  .

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Cross sectional and colour images of a high sinus venosus atrial septal defect. The scanning plane has been tilted upwards to show the entry of the superior vena cava, which is shown to override the atrial septum. An anomalous pulmonary vein is not shown. SVC, superior vena cava; others as before.

Figure 4  .

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Cross sectional and colour images from a woman with an atrial septal aneurysm. (A) The aneurysm bulges into the right atrium and there are areas of echo dropout which might suggest a defect. (B) Colour is necessary to determine whether there is a defect and identify its site.

Figure 5  .

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Transoesophageal echocardiography images in a patient with a large secundum atrial septal defect showing the defect and flow from the left to right atrium. The defect reaches to near the aorta and only a small edge of atrial septum is seen next to it at this margin. Ao, aortic root; others as before.

Figure 6  .

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Transoesophageal echocardiography images in a patient with a sinus venosus atrial septal defect showing the defect (arrow) and flow from the left (LA) to right (RA) atrium. The defect is shown in the upper and posterior part of the septum at the entrance of the superior vena cava.

Figure 7  .

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Left parasaggital view in a patient with partial anomalous pulmonary venous drainage of the left upper pulmonary vein to the innominate. The pulmonary vein enters a left ascending vein (LSVC) which joins the innominate vein (Inn vein). Colour shows the flow is upwards to the innominate.

Figure 8  .

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Parasternal four chamber view in a patient with an ostium primum atrial septal defect. The atrioventricular valves are attached to the edge of the ventricular septum at the same level and there is a large gap in the septum primum between the ventricular and the atrial septae.

Figure 9  .

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Left parasaggital view of the arterial duct in a teenage girl. The duct is shown as a continuation of the main pulmonary artery (MPA) into the descending aorta (Desc Ao). Ao Arch, aortic arch; others as before.

Figure 10  .

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Spectral Doppler signal of ductal flow in ductus arteriosus with low pulmonary artery pressure. The signal is a continuous one reaching its maximum velocity (4.3 m/s) in mid-systole and then falls off until just after the R wave.

Figure 11  .

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Left parasternal views in a woman with Eisenmenger's syndrome and patent ductus arteriosus. The duct is imaged as a continuation of the main pulmonary artery (MPA) into the descending aorta (DAo). Flow is bidirectional, from the pulmonary artery to aorta in systole (top) and aorta to pulmonary artery in diastole (bottom).

Figure 12  .

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Colour Doppler demonstration of flow through the duct into the pulmonary artery in a woman with a "silent" duct. PA, pulmonary artery; AO, aorta; others as before.

Figure 13  .

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Images from a man with a fistula from the right coronary artery to the right atrium. The transoesophageal image (left) shows a very dilated right coronary artery which passes anteriorly and then sharply posteriorly. The transthoracic image (right) shows the jet flowing into the right atrium towards the right wall and then anteriorly; others as before.

Figure 14  .

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Colour Doppler image in a man with a sinus of Valsalva aneurysm showing flow from the aortic root into the right atrium.

Figure 15  .

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Colour Doppler image of a tiny apical ventricular septal defect (VSD). The defect cannot be shown with imaging alone but is readily identified with colour.

Figure 16  .

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Spectral Doppler recording of flow through a small ventricular septal defect from left to right ventricle. It demonstrates a sharp rise in systole to the mid-systolic plateau and then a sharp fall at end systole. The maximum velocity of about 4 m/s represents a pressure difference between the ventricles of about 64 mm Hg.

Figure 17  .

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Spectral Doppler recording of flow through a ventricular septal defect in a woman with Eisenmenger's syndrome. The velocity is low (maximum 2.3 m/s) and the pattern demonstrates flow from left to right (above the line) in systole and bidirectional in diastole.

Figure 18  .

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Transoesophageal study showing a mid-muscular ventricular septal defect in a man in whom it was poorly seen with transthoracic echocardiography.

Figure 19  .

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Long axis views in a patient with subaortic ventricular septal defect and aortic valve prolapse. The image shows that the right coronary cusp is prolapsing into the defect and limiting its size and the colour demonstrates the residual flow through the lower part of the ventricular septal defect.

Figure 20  .

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Transoesophageal image of the main pulmonary artery (MPA) and left pulmonary artery (LPA) in a patient who has undergone repair of tetralogy of Fallot. The narrowing in the MPA is indicated by the increased flow velocity on colour Doppler. The LPA and its branches are of good size with no narrowed areas.

Figure 21  .

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Views along the right ventricular outflow tract (RVOT) and main pulmonary artery in a patient who has undergone repair of tetralogy of Fallot. The right ventricle, outflow tract and pulmonary artery are dilated and there is jet of pulmonary regurgitation occupying the full width of the pulmonary ring.

Figure 22  .

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Long axis view in a patent with a subaortic membrane (arrow).

Figure 23  .

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Transoesophageal echocardiography image of a subaortic membrane which is very closely related to the aortic valve and difficult to show with transthoracic imaging. AOV, aortic valve; LVOT, left ventricular outflow tract; others as before.

Figure 24  .

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Spectral recordings of flow in the distal aortic arch from patients with mild (upper) and severe (lower) coarctation. In addition to the higher velocity of the severe obstruction the signal continues throughout diastole while in the less severe one the signal is only systolic.

Figure 25  .

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Four chamber view in a patient with Ebstein's anomaly of the tricuspid valve showing it to be apically displaced. The left ventricle (LV) and atrium (LA) are small and the right atrium (RA) large consisting of the true atrium and the "atrialised" right ventricle (RV).

Figure 26  .

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Four chamber view in a patient with corrected transposition of the great arteries. The left sided valve is more apically positioned indicating a left sided right ventricle (RV) and thus a right sided left ventricle (LV).

Figure 27  .

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Four chamber view in a patient with tricuspid atresia and a Fontan repair. There is no apparent tricuspid valve and a single ventricular chamber. There appears to be a break in the atrial septum but this is echo dropout and none was demonstrated with colour imaging.

Figure 28  .

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Transthoracic apical four chamber study of total cavopulmonary connection. The left image shows a double inlet ventricle and the proximity of the intra-atrial conduit to the right valve and the right shows colour flow through a surgically created fenestration and then through the atrioventricular valve to the ventricular chamber. The spectral Doppler trace of flow through the fenestration (below) shows right to left flow which is continuous and of relatively high velocity.

Figure 29  .

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Transoesophageal study in a patient with a classic Fontan showing flow through the anastomosis and into the main pulmonary artery (MPA) on colour. The spectral signal (below) shows the typical triphasic appearance with forward flow (towards the transducer) in atrial systole followed by a brief retrograde flow in atrial relaxation and subsequent forward flow of lower velocity until atrial systole. RAA, right atrial appendage.

Figure 30  .

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Diagrammatic representation of the spectral flow signals. With classic Fontan there is a distinct peak of forward flow with atrial systole, but this is lost in the total cavopulmonary connection (TCPC).

Figure 31  .

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Schematic diagram demonstrating inflow redirection in the Mustard and Senning procedure. An intra-atrial baffle (IAB) is constructed from the mouth of each of the venae cavae and channelled to the left of the pulmonary veins to join and form a single channel directed to the mitral valve (MV) orifice. The pulmonary venous flow passes anterior to the inferior limb into the tricuspid valve (TV) orifice. IVC, inferior vena cava; PVA, pulmonary venous atrium; PVs, pulmonary veins; SVA, systemic venous atrium; SVC, superior vena cava.

Figure 32  .

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Modified subcostal transthoracic view in a Mustard correction with colour Doppler demonstrating flow acceleration through the pulmonary venous atrial anastomosis and the spectral signal showing continuous flow. PVA, pulmonary venous atrium; Pulm veins, pulmonary veins.

Figure 33  .

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Parasternal four chamber views of patient with a Mustard procedure and pulmonary to systemic baffle leak. The upper image is in end diastole and shows the right ventricle (RV) to be enlarged and hypertrophied but the left ventricular (LV) size is not reduced because of a pulmonary to systemic shunt. A right sided pulmonary vein is seen draining into the pulmonary venous chamber. The lower frame is taken in systole and colour Doppler shows a low velocity shunt through the baffle leak.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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