echocardiography in adult congenital heart diseaseechocardiography in adult congenital heart disease...
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Echocardiography in adult congenital heart disease
Michael Vogel
Kinderherz-Praxis München
Echocardiography inAdult Congenital Heart Disease
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Echocardiography in adult congenital heart disease
CHD missed in childhood
Subsequent lesions after “repaired” CHD
Follow-up of cyanotic heart disease
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Echocardiography in adult congenital heart disease
CHD missed in childhood
Atrial septal defect, Sinus venosus defect
Coarctation of the Aorta
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Echocardiography in adult congenital heart disease
Atrial septal defect Sinus venosus Defect
18-23% present with atrial flutter
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Echocardiography in adult congenital heart disease
Atrial septal defect
Long axis 4 chamber
RV
RVLVLV
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Echocardiography in adult congenital heart disease
Atrial septal defect
RV
Transoesophageal
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Echocardiography in adult congenital heart disease
3D transthoracic echo
Anatomic Specimen 3D Echo
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Echocardiography in adult congenital heart disease
Sinus Venosus defect
Subcostal
RA
LA
RA
LA
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Echocardiography in adult congenital heart disease
Sinus Venosus defect
TransoesophagealSubcostal
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Echocardiography in adult congenital heart disease
Coarctation of the Aorta
“treatable” cause of Hypertension
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Echocardiography in adult congenital heart disease
Coarctation of the aorta
MRI best Image
Blood pressureand
femoral artery pulse most important
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Echocardiography in adult congenital heart disease
Coarctation of the aorta
difficult imaging of aortic arch in adults
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Echocardiography in adult congenital heart disease
Coarctation of the aorta
Doppler gradient more diagnostic
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Echocardiography in adult congenital heart disease
Coarctation of the aorta
Abnormal Doppler flow in abdominal aorta
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Echocardiography in adult congenital heart disease
Subsequent lesionsin “repaired”CHD
DCRV SubAS
after surgical or spontaneousclosure of VSD
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Echocardiography in adult congenital heart disease
Perimebranous VSD
4 Chamber view in 2000
Spontaneous closure11 years ago (2001)
New murmur,Normal P2
ECG: RVH
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Echocardiography of adult congenital heart disease
Double chambered right ventricle
Short axis in 2012
AoRA
RV
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Echocardiography of adult congenital heart disease
Double chambered right ventricle
Subcostal
RA
RV
RV
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Echocardiography of adult congenital heart disease
Subaortic Stenosis
4 chamber view
LV LV
AoAo
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Echocardiography of adult congenital heart disease
Follow-up ofCommon cyanotic heart defects
Tetralogy of Fallot
Transposition after atrial repair
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Echocardiography of adult congenital heart disease
Tetralogy of Fallot
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Echocardiography of adult congenital heart disease
Tetralogy of FallotPulmonary regurgitation
with RV Dilatation
TV incompetenceRV dysfunction
LV dysfunction
Aortic root dilatation
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Echocardiography of adult congenital heart disease
Tetralogy of Fallot
Pulmonary regurgitation leads to RV Dilatation and TV incompetence
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Echocardiography of adult congenital heart disease
Tetralogy of Fallot
RV Function: Volumetric data by transthoracic 3D-echo
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Echocardiography of adult congenital heart disease
Tetralogy of Fallot
RV Function: TAPSE
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Echocardiography of adult congenital heart disease
Tetralogy of Fallot
RV Function: TAPSE and myocardial Doppler
s-wave
e- wave
a-wave
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Echocardiography of of adult congenital heart disease
Tetralogy of Fallot
Aortic root dilatation
LVAo
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Echocardiography of adult congenital heart disease
Transposition after atrial repairBaffle obstruction
Tricuspid valveDysfunction
Systemic (right ventricular)
dysfunction
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Measurement of IVA and pressure-volume loops
s wave
a wave
e wave
0
Myocardial Doppler Conductance catheter
Echocardiography in adult congenital heart disease
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Echocardiography in adult congenital heart disease
BeforeIVA= 7m/s2
DuringIVA= 2.8m/s2
-10
0
10
20
30
40
50
60
70
80
0 10 20 30 40 50 60
Ees 2.8 ml/mmHg Ees 1.8 ml/mmHg
Dobutamine 10 mcgs/kg/min Baseline
Pres
sure
Volume
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50
100
150
200
250
300
350
400
0 50 100 150 200 250 300 350
Correlation between change in IVA and end-systolic elastance
in 12 patients with TGA after Mustard
% C
hang
e IV
A
% Change Ees
r = 0.68p < 0.002
Echocardiography in adult congenital heart disease
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Echocardiography in adult congenital heart disease
Thank you for your attention
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Echocardiography in adult congenital heart disease