Table 6. Recommendations for echocardiography in adults with congenital heart disease^{9,29,36,38–44} .

Recommendations	Recommendation class	Evidence level
Initial structural and functional assessment in suspected congenital heart disease because of murmur, cyanosis, poor arterial saturation, or abnormal electrocardiogram or chest X-ray findings	I	C
Changes in the clinical status of a patient with known congenital heart disease, whether operated or not	I	C
Doubts with regard to original diagnosis or unexplained structural or hemodynamic abnormalities in a patient with known congenital heart disease	I	C
Follow-up of patients with intraventricular communication for assessment of evolving morphological changes	I	C
Periodic follow-up of patients with congenital heart disease, operated or not, in whom assessment of contraction, valve, and conduction function is needed	I	C
Postoperative annual follow-up after total, partial, or palliative repair in patients with residual defects and sequelae that could compromise clinical progress	I	C
Identification of the origin and initial course of the coronary arteries	I	C
Assessment of unexplained post-exercise syncope for initial diagnostic definition	I	C
Evaluation of aortic injury in patients with suspected or confirmed Marfan Syndrome for serial assessment of the aorta and/or mitral valve	I	C
Periodic examinations in patients operated for PDA, ASD, VSD aortic coarction or bicuspid aortic valve, without residual defect and without changes in clinical condition	III	C
Follow-up of patients with heart diseases without hemodynamic significance and without changes in clinical condition	III	C
Assessment of lesions in the aortic arch, pulmonary arteries and collateral arteries, the anatomy of which is better defined using other diagnostic methods	III	C
Periodic assessment of cardiac malformations without changes in physical examination findings, in the clinical condition of the patient, or in other examinations such as electrocardiogram and chest X-ray	III	C

ASD: atrial septal defect; PDA: patent ductus arteriosus; VSD: ventricular septal defect.