Two-dimensional echocardiography in the older child.

The role of two-dimensional echocardiography in the management of any congenital cardiovascular anomaly depends on the lesion's natural history and surgical alternatives. Diagnostic assessment of subaortic stenosis and postoperative follow-up of Fontan and Mustard/Senning procedures and tetralogy of Fallot reconstruction illustrate the application of two-dimensional echocardiography to the management of these problems in the older child. Two-dimensional echocardiography displays the static anatomic as well as dynamic functional sequels of left ventricular outflow obstruction. Detailed anatomic display of Fontan reconstruction is compromised by its somewhat unpredictable spatial organization. Combining two-dimensional imaging with gated pulsed Doppler techniques, however, supplements limited anatomic definition with flow profile data specific to the varied surgical interpretations of the Fontan principle. In a similar manner, combined imaging after Senning/Mustard procedures permits detailed anatomic and hemodynamic interrogation of pulmonary and systemic venous return to the neo-left and neo-right atria. The limitations of cardiac ultrasound imaging of the older child after tetralogy of Fallot reconstruction offer some insight into the future directions that are necessary in the application of this imaging technique. Imaging of these patients is compromised by the prosthetic material, which compromises the assessment of right ventricular outflow pulmonary artery reconstruction and ventricular septal closure. Although gated pulsed Doppler echocardiography overcomes some of these limitations, better tissue characterization in the presence of bioprosthetic material is necessary.