Multiple Crystal Cross-Sectional Echocardiography in the Diagnosis of Cyanotic Congenital Heart

A new multiple crystal echocardiographic system was used to assess cross-sectional cardiac anatomy in real time in fifty infants and children with cyanotic heart disease, and the findings were compared to normals. Four standard transducer positions were employed to evaluate sagittal and transverse cardiac crosssections. Studies in patients with tetralogy of Fallot demonstrated an enlarged aorta overriding the septum with preservation of mitral-aortic continuity. In the absence of pulmonary atresia the main pulmonary artery could be identified in all of these patients. The diagnosis of d-transposition of the great vessels was established by viewing great vessel orientation in transverse section at the second intercostal space and observing a rightward and anteriorly placed great artery. In sagittal projections a retrosternal aorta and mitral-pulmonic continuity was observed. In one patient with d-transposition, apposition in systole of the ventricular septum and anterior leaflet of the mitral valve was identified as the cause of left ventricular outflow tract obstruction. Descriptions are provided of the findings in patients with i-transposition, double outlet right ventricle, and truncus arteriosus. The new multiscan method allows a substantially more precise determination of intraand extra-cardiac spatial relationships than single crystal techniques. Multiscan echocardiography is safe, widely applicable, and provides clinically important information to assist in the diagnosis and management of infants and children with cyanotic heart disease.