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Echocardiographic Identification of Congenital Cardiac Anomalies

2D and Doppler echocardiography has had a major impact on the diagnosis and management of patients with congenital heart disease (see also Chaps. 63 and 64). From isolated congenital lesions to complex, extensive cardiac malformations, echocardiographic imaging (often with intravenous contrast injection) is usually sufficient to delineate cardiac anatomy. TEE is an important adjunctive technique as well554; in many cases, a thorough echocardiographic evaluation may obviate the need for cardiac catheterization and angiography.555-557

The ultrasound diagnosis of a simple intracardiac shunt is usually straightforward, but the task of defining complex congenital cardiac abnormalities can be daunting. In these cases, it is useful to remember a few basic anatomic rules. The venae cavae and pulmonary veins generally empty into the morphologic right atrium and LA, respectively. The atrioventricular valves uniformly follow their ventricles through embryologic development: a tricuspid valve accompanies the morphologic right ventricle and a mitral valve accompanies the left. Similarly, the semilunar valves follow the great vessels. The aorta and pulmonary artery can be distinguished, regardless of their position, by the bifurcation of the pulmonary artery.

Several features aid identification of the morphologic right and left ventricles. The right ventricle has a tricuspid atrioventricular valve; in comparison with the mitral annulus, the tricuspid annulus is positioned slightly closer to the cardiac apex.558 The right ventricle also has a moderator band, coarser trabeculations than those in the left ventricle, and an infundibulum that separates the inlet area from the right ventricular outflow tract.

Cardiovascular Shunts

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