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Segmental approach to congenital heart disease

Historically, there have been two main schools of nomenclature of congenital heart defects, the foundations of which were laid in parallel by Robert Anderson from the United Kingdom and by Richard and Stella Van Praagh from the United States. For this reason, the “Andersonian” approach is used predominantly in Europe, while the “Van Praaghian” approach is more common in the United States. Despite many similarities, the…

Normal transthoracic echocardiogram in a child

Transthoracic echocardiography is the first-line imaging modality for the diagnosis of congenital and acquired heart conditions in children. It allows a detailed morphological and functional examination of different cardiac structures. A standard echocardiographic study consists of two-dimensional (2D) imaging, motion mode (M-mode), and Doppler imaging. The analysis of cardiac anatomy is based on cross-sectional visualization of the heart in conventional 2D planes, which show the real-time…

Use of the Cropping Tool to Show Structures of Interest

Summary This chapter provides several examples of how to crop a real-time three-dimensional (RT3D) image to show a particular structure of interest. Q-lab, a software program developed by Philips Medical Systems, is used in the examples, but other similar software programs are available. One goal of this chapter is to show how to think in three dimensions and how to eliminate unnecessary parts of the 3D…

Evaluation of Intracardiac Masses

Introduction Perhaps no finding on echocardiography creates a bigger diagnostic challenge than the presence of an intracardiac mass. This is because tissue characterization by any imaging modality is limited. The advent of tomographic imaging in general, including computed tomography (CT), magnetic resonance imaging, and echocardiography, has dramatically improved the detection of intracardiac masses, but mass characterization remains challenging. The diagnosis of some masses, particularly thrombi, can…

Congenital Heart Disease

In patients with congenital heart disease, a complete and accurate description of the morphologic abnormalities is crucial for determining appropriate management strategies. Currently, two-dimensional echocardiography (2DE) allows a complete description of the intracardiac anatomy of different congenital lesions. Because of its high spatial and temporal resolution, 2DE is still the mainstay technique for the diagnosis and follow-up of patients with congenital defects. However, the representation of…

Assessment of Right Ventricular Function

The right ventricle (RV) is often overlooked because most cardiologists focus their attention on the left ventricle (LV). Early work characterizing ventricular anatomy and physiology was performed on the LV and then assumed to be similar in the RV. Methods for measuring ventricular volume and function from the various imaging modalities were similarly developed for the LV and then applied to the RV. However, more recent…

Assessment of Left Ventricular Mechanical Dyssynchrony

Real-time three-dimensional echocardiography (RT3DE) has proven to be the most reliable and reproducible echocardiographic measure of left ventricular volumes, ejection fraction (EF), and mass. The advent of the matrix array transducer and improvements in parallel processing technologies have improved the temporal and spatial resolution of the volumes acquired, and full left ventricle (LV) datasets can now be obtained in a single heartbeat on some commercial systems.…

Volumetric Assessment

The rationale for the use of three-dimensional echocardiography (3DE) in a clinical setting is growing stronger. The four main areas in which the value of 3DE has been investigated include (1) the analysis of cardiac volumes and left ventricular mass, (2) ischemic heart disease, (3) congenital heart disease, and (4) valvular pathology. Although various versions of 3DE have been in use since the early 1970s, “live”…

Pulmonary Valve in Health and Disease

The pulmonary valve is the smallest valve in the body and, in keeping with its size, plays a relatively uncommon role in adult cardiology. Despite the limited involvement of the pulmonary valve in adult cardiac disorders, it is important to review the clinical situations for which pulmonary valve pathology is present. Pulmonic stenosis rarely is identified in adulthood and is a problem much more frequently identified…

Tricuspid Valve

Introduction The tricuspid valve is the largest of the four heart valves and ranges from 4 to 6 cm 2 in area. The tricuspid valve has anterior, septal, and posterior leaflets. The anterior leaflet usually is the largest, with a width of 2.2 cm. The septal and posterior leaflets are notably smaller and measure roughly 1.5 and 2.0 cm, respectively, based on autopsy series. Our experience shows that the…