PROBLEMS OF NONINVASIVE ASSESSMENT OF ADU LT CONGENITAL HEART-DISEASE

Non-invasive assessment of adult congenital heart disease comprises Do ppler echocardiography and magnetic resonance imaging (MRI). Doppler e chocardiography represents the modality of choice to perform serial fo llow-up and MRI is used as supplementary method in the diagnosis of co ngenital heart disease in adults. The spectrum of congenital heart dis ease in adults encompasses (a) uncorrected and newly detected defects; (b) palliatively corrected and totally corrected defects. In general, diagnostic modalities must be able to fulfill the following requireme nts: (a) sequential morphologic analysis; (b) assessment of hemodynami cs. Sequential morphologic analysis using 2-dimensional echocardiograp hy includes determination of the situs of the atria, atrio-ventricular and ventriculo-arterial connections. Non-invasive assessment of hemod ynamics is performed with the Doppler technique and comprises diagnosi s and quantitation of (a) (residual) shunt lesions, (b) valvular regur gitation and (c) valvular, subvalvular, supravalvular and infundibular stenosis as well as pressure gradients across anastomoses and intraca vitary or intercavitary gradients, respectively. Pulmonary vascular re sistance cannot be assessed quantitatively by Doppler. However, the de termination of the end-diastolic gradient between the pulmonary artery and the right ventricle in the presence of pulmonic regurgitation all ows estimation of the diastolic pulmonary artery pressure.