Deductive Echocardiographic Diagnosis in Congenital Heart Disease

Abstract

It is common practice to think about congenital heart disease in terms of predetermined entities. Echocardiography has certainly not prevented this tendency, as this technique offers the possibility of recognizing many forms of CHD directly. Indeed, much in echocardiography is pattern recognition. Overriding of the septum by an enlarged vessel brings to mind the possibility of tetralogy of Fallot; however, this ultrasonic sign can be seen in pulmonary atresia, or truncus ateriosus, or even in a Taussig-Bing anomaly. Pattern recognition is thus not sufficient. To arrive at an echocardiographic diagnosis of a complex heart abnormality, a more logical, step-by-step approach is necessary. This can be accomplished by conceptually dividing the heart into its 3 major anatomical segments: the atria, the ventricles and the great arteries. By applying this segmental approach, which has been advocated by Van Praagh, it will be possible, most of the time, to arrive at a correct ultrasonic diagnosis. A schematic outline of the diagnostic steps to be solved is given in the following table:

• 1. The atrial situs,

• 2. The location and identification of the ventricles,

• 3. The identification of the great arteries,

• 4. The ventriculo-arterial connections,

• 5. Presence of obstructive lesions,

• 6. Presence of cardiovascular shunts.