Echocardiography in Adult Congenital Heart Disease Michael Vogel Kinderherz-Praxis München
CHD missed in childhood Subsequent lesions after repaired CHD Follow-up of cyanotic heart disease
CHD missed in childhood Atrial septal defect, Sinus venosus defect Coarctation of the Aorta
Atrial septal defect Sinus venosus Defect 18-23% present with atrial flutter
Atrial septal defect RV LV RV LV Long axis 4 chamber
Atrial septal defect RV Transoesophageal
3D transthoracic echo Anatomic Specimen 3D Echo
Sinus Venosus defect LA LA RA RA Subcostal
Sinus Venosus defect Subcostal Transoesophageal
Coarctation of the Aorta treatable cause of Hypertension
Coarctation of the aorta MRI best Image Blood pressure and femoral artery pulse most important
Coarctation of the aorta difficult imaging of aortic arch in adults
Coarctation of the aorta Doppler gradient more diagnostic
Coarctation of the aorta Abnormal Doppler flow in abdominal aorta
Subsequent lesions in repaired CHD DCRV SubAS after surgical or spontaneous closure of VSD
Perimebranous VSD 4 Chamber view in 2000 Spontaneous closure 11 years ago (2001) New murmur, Normal P 2 ECG: RVH
Echocardiography of adult congenital heart disease Double chambered right ventricle RV RA Ao Short axis in 2012
Echocardiography of adult congenital heart disease Double chambered right ventricle RA RV RV Subcostal
Echocardiography of adult congenital heart disease Subaortic Stenosis Ao Ao LV LV 4 chamber view
Echocardiography of adult congenital heart disease Follow-up of Common cyanotic heart defects Tetralogy of Fallot Transposition after atrial repair
Echocardiography of adult congenital heart disease Tetralogy of Fallot
Echocardiography of adult congenital heart disease Tetralogy of Fallot Pulmonary regurgitation with RV Dilatation TV incompetence RV dysfunction LV dysfunction Aortic root dilatation
Echocardiography of adult congenital heart disease Tetralogy of Fallot Pulmonary regurgitation leads to RV Dilatation and TV incompetence
RV Function: Volumetric data by transthoracic 3D-echo Echocardiography of adult congenital heart disease Tetralogy of Fallot
Echocardiography of adult congenital heart disease Tetralogy of Fallot RV Function: TAPSE
Echocardiography of adult congenital heart disease Tetralogy of Fallot s-wave e- wave a-wave RV Function: TAPSE and myocardial Doppler
Echocardiography of of adult congenital heart disease Tetralogy of Fallot LV Ao Aortic root dilatation
Echocardiography of adult congenital heart disease Transposition after atrial repair Baffle obstruction Tricuspid valve Dysfunction Systemic (right ventricular) dysfunction
Measurement of IVA and pressure-volume loops s wave 0 e wave a wave Myocardial Doppler Conductance catheter
Dobutamine 10 mcgs/kg/min Baseline 80 70 60 50 Before IVA= 7m/s 2 During IVA= 2.8m/s 2 40 30 20 10 0-10 Pressure Volume 0 10 20 30 40 50 60 Ees 2.8 ml/mmhg Ees 1.8 ml/mmhg
Correlation between change in IVA and end-systolic elastance in 12 patients with TGA after Mustard 400 % Change IVA 350 300 250 200 150 100 r = 0.68 p < 0.002 50 0 50 100 150 200 250 300 350 % Change Ees
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