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With a sound understanding of anatomy, detecting and diagnosing most congenital heart malformations with echocardiography need not be an onerous task. Using all the modalities of ultrasound, the examination should define as completely as possible the morphological and physiological aspects of the malformation. The cross sectional imaging modality is a superb tool for displaying the morphology of intracardiac and vascular anomalies. In this review we provide the anatomical correlates to the more common forms of congenital cardiac defects.
Description and display
Transthoracic echocardiography accesses the heart through the parasternal, suprasternal, apical, and subcostal windows. Similar views of the heart can also be obtained by the transoesophageal and transgastric windows. Innumerable series of planes can be displayed through each window. Since the orthogonal planes of the heart are different from the major axes of the body it is conventional to describe the window of access as well as the reference plane—for example, the parasternal long axis plane (fig 1). It is also appropriate to display the image in as near anatomical orientation as possible. The sector fan can be inverted on the modern ultrasound equipment. This is a most useful facility when interrogating complex malformations. Operators no longer need to reorient the images mentally or stand on their heads in order to figure out the relative position of structures!
Upper panel: Diagrams showing the orthogonal planes of the body at an angle to that of the heart and the transthoracic windows for accessing the heart. Middle panels: The parasternal approach produces cuts through the short and long axes of the heart itself whereas the apical approach yields long axis two and four chamber cuts. Lower panels: Access from the subcostal window yields short and long axis cuts through the heart that are in parasagittal and paracoronal planes of the body.
The basic planes
The body and the …