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
Echocardiography in adult congenital heart disease
CHD missed in childhood
Subsequent lesions after “repaired” CHD
Follow-up of cyanotic heart disease
Echocardiography in adult congenital heart disease
CHD missed in childhood
Atrial septal defect, Sinus venosus defect
Coarctation of the Aorta
Echocardiography in adult congenital heart disease
Atrial septal defect Sinus venosus Defect
18-23% present with atrial flutter
Echocardiography in adult congenital heart disease
Atrial septal defect
Long axis 4 chamber
RV
RVLVLV
Echocardiography in adult congenital heart disease
Atrial septal defect
RV
Transoesophageal
Echocardiography in adult congenital heart disease
3D transthoracic echo
Anatomic Specimen 3D Echo
Echocardiography in adult congenital heart disease
Sinus Venosus defect
Subcostal
RA
LA
RA
LA
Echocardiography in adult congenital heart disease
Sinus Venosus defect
TransoesophagealSubcostal
Echocardiography in adult congenital heart disease
Coarctation of the Aorta
“treatable” cause of Hypertension
Echocardiography in adult congenital heart disease
Coarctation of the aorta
MRI best Image
Blood pressureand
femoral artery pulse most important
Echocardiography in adult congenital heart disease
Coarctation of the aorta
difficult imaging of aortic arch in adults
Echocardiography in adult congenital heart disease
Coarctation of the aorta
Doppler gradient more diagnostic
Echocardiography in adult congenital heart disease
Coarctation of the aorta
Abnormal Doppler flow in abdominal aorta
Echocardiography in adult congenital heart disease
Subsequent lesionsin “repaired”CHD
DCRV SubAS
after surgical or spontaneousclosure of VSD
Echocardiography in adult congenital heart disease
Perimebranous VSD
4 Chamber view in 2000
Spontaneous closure11 years ago (2001)
New murmur,Normal P2
ECG: RVH
Echocardiography of adult congenital heart disease
Double chambered right ventricle
Short axis in 2012
AoRA
RV
Echocardiography of adult congenital heart disease
Double chambered right ventricle
Subcostal
RA
RV
RV
Echocardiography of adult congenital heart disease
Subaortic Stenosis
4 chamber view
LV LV
AoAo
Echocardiography of adult congenital heart disease
Follow-up ofCommon 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 FallotPulmonary regurgitation
with RV Dilatation
TV incompetenceRV dysfunction
LV dysfunction
Aortic root dilatation
Echocardiography of adult congenital heart disease
Tetralogy of Fallot
Pulmonary regurgitation leads to RV Dilatation and TV incompetence
Echocardiography of adult congenital heart disease
Tetralogy of Fallot
RV Function: Volumetric data by transthoracic 3D-echo
Echocardiography of adult congenital heart disease
Tetralogy of Fallot
RV Function: TAPSE
Echocardiography of adult congenital heart disease
Tetralogy of Fallot
RV Function: TAPSE and myocardial Doppler
s-wave
e- wave
a-wave
Echocardiography of of adult congenital heart disease
Tetralogy of Fallot
Aortic root dilatation
LVAo
Echocardiography of adult congenital heart disease
Transposition after atrial repairBaffle obstruction
Tricuspid valveDysfunction
Systemic (right ventricular)
dysfunction
Measurement of IVA and pressure-volume loops
s wave
a wave
e wave
0
Myocardial Doppler Conductance catheter
Echocardiography in adult congenital heart disease
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
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
Echocardiography in adult congenital heart disease
Thank you for your attention
Echocardiography in adult congenital heart disease