Table 1

A protocol for transoesophageal echocardiography in adult congenital heart disease

1. Establish cardiac situs and connections as defined in table 3
 2. Examine the morphology and function (two dimensional echo), flow and haemodynamics (colour and spectral Doppler) of each structure as follows:
ProtocolAssessmentExamples
Systemic “circuit”
 AtriumAtrial morphologyCor triatriatum
Pulmonary venous connectionsAnomalous drainage
Pulmonary venous baffleMustard/Senning
Atrial septumASD
 AV connectionAtrioventricular septumPartial, intermediate, complete AVSD
AV valve morphologyCleft, accessory, parachute mitral valve
Supramitral ring
 VentricleMorphology, size and function
Ventricular septumVSD
Outflow tractSubaortic membrane, tunnel, HOCM
 VA connectionAortic valveBicuspid, etc.
 Great arteryAortaTransposition, Malposition etc.
Truncus arteriosus
PDA, aortopulmonary window
Coarctation
Blalock-Taussig, Waterston, Potts shunts
Pulmonary “circuit”
 AtriumAtrial morphologyFontan connections
Coronary sinusLeft SVC, unroofed CS
 AV connectionAV valve morphologyEbsteins anomaly
 VentricleMorphology, size and function
Outflow tractRight ventricular infundibular stenosis
Double chamber right ventricle
Tetralogy of Fallot
 VA connectionPulmonary valveBicuspid, etc.
 Great arteryPulmonary arteriesSupra PS
Branch PS
  • AV, atrioventricular; ASD, atrial septal defect; AVSD, atrioventricular septal defect; CS, coronary sinus; HOCM, hypertrophic obstructive cardiomyopathy; PDA, patent ductus arteriosus; PS, pulmonary stenosis; SVC, superior vena cava; VA, ventriculoatrial; VSD, ventricular septal defect.