DIAGNOSIS OF CYANOTIC CONGENITAL HEART MALFORMATIONS IN INFANTS BY REAL-TIME, TWO-DIMENSIONAL ECHOCARDIOGRAPHY

The accuracy of real-time, two-dimensional echocardiography in diagnosing malformations of the great vessels was assessed in 11 infants (aged 5 to 29 months) with angiographically documented transposition of the great arteries (TGA), tetralogy of Fallot (TF) or pulmonary atresia. Adequate studies were obtained in 10 of the 11 infants. A great artery cross-sectioned by the echo beam (i.e., scanning the heart perpendicular to its long axis, at the origin of the great arteries) appears as a circle; when sectioned longitudinally it is sausage-shaped. TF was characterized by normally related great arteries; a posteriorly positioned circle (aorta) and an anterior, sausage-shaped structure (RV outflow tract). In pulmonary atresia, a large posterior circle (aorta) and an anterior sausage-shaped structure, ending proximal to the pulmonary valve (atretic outflow tract) were seen. In TGA, a posterior circle (pulmonary artery) was associated with another circle (aorta) which was located anteriorly and to its right (D-transposition). Thus, this technique provides a painless, rapid and accurate means of diagnosing congenital malformations of the great arteries in infants. It therefore may obviate the need for complete angiographlc studies in some seriously ill infants with cyanotic congenital heart disease.