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Cardiac ultrasound and the study of congenital cardiac malformations seem to be made for each other. The understanding of cardiac malformations has improved in parallel with technological advances in ultrasound. Development of both spheres of interest has been remarkable for the rapidity of change, the increasing complexity of the lesions treated, and the technology applied.
Paediatric cardiologists in the 1960s and '70s depended on long and difficult catheterisation procedures on small blue and sick infants to make accurate diagnoses. These were often performed as an emergency so that the treatable lesions such as transposition of the great arteries and coarctation syndrome could be recognised early and sent for surgery.
It would have been difficult to predict the utility of cardiac ultrasound for diagnosing neonatal congenital heart disease from the early reports by Edler and Gustavson demonstrating echos from the mitral valve with an industrial device originally used for the examination of metal fatigue.1 Cardiac ultrasound consisted only of M mode with its high resolution, rapid repetition, but very limited view of the heart. As such it was not an obvious diagnostic tool for complex congenital cardiac malformations.
In the paediatric cardiology unit in Newcastle around this time, serendipity took a hand. An echocardiogram on a blue neonate was …