Identification of congenital malformations of the great arteries in infants by real-time two-dimensional echocardiography.

Real-time, two dimensional echocardiography was used to identify great artery relations in 23 infants and small children, including 16 patients with angiography documented transposition of the great arteries, tetralogy of Fallot, or pulmonary aresia. Using this technique, the heart was scanned perpendicular to its long axis at the origin of the great arteries. Great arteries cross-sectioned perpendicular to their long axes appear as circles; when sectioned longitudinally these arteries appeared as elongated sausage-shaped structures. I- patients with normally related great arteries, a curcular structure (aorta) always was positioned posterior to an elongated, sausage-shaped structure (distal right ventricular outflow tract and proximal main pulmonary artery). In transposition of the great arteries, two adjacent circular structures were observed; the anterior circle (aorta) was located to the right, left or directly anterior to the posterior circle (pulmonary artery). In pulmonary atresia or hypoplasis, a large posterior circle (aorta) was associated with an anteriorly positioned structure that was either short and small (atretic right ventricular outflow tract) or elongated with an area of severe narrowing (hypoplastic right ventricular outflow tract). Thus, real-time two-dimensional echocardiography provides a rapid, noninvasive means of accurately identifying congenital malformations of the great arteries in infants and small children and may be a useful adjunct to cardiac catheterization in the diagnosis of cyanotic congenital heart disease.