Congenital anatomy, acquired pathology – A synergistic approach to echocardiographic evaluation of the adult with congenital heart disease

Echocardiographic evaluation of an adult with congenital heart disease (ACHD) must thoroughly address both underlying anatomic complexity and acquired pathology. For a complete assessment in these complex cases, the ACHD practitioner benefits from techniques developed in both adult and pediatric echocardiography laboratories. The strengths of the two laboratories can be complementary for theACHDpractitioner. Pediatric echocardiographic examination is tailored for the anatomic characterization of congenital heart diseases, including changes from birth and somatic growth. Invasive structural palliations may be necessary in childhood, and echocardiographic examination includes evaluation of shunts and conduits when necessary. Adult echocardiographic examination, by contrast, is tailored for acquired heart diseases whose prevalence largely increase with age, such as ischemic heart disease and calcific aortic stenosis.While adults may undergo invasive procedures, anatomic factors such as cardiac situs and chamber orientation are generally assumed to fit a consistent pattern. Consensus recommendations from the International Society of Adult CongenitalHeartDisease1 acknowledge thatACHDechocardiography expertise is unique, and requires drawing from the strength of each laboratory. In practice, though, combining the approaches can be challenging.