Two-dimensional echocardiography and its influence on cardiac catheterization.

Successful management of congenital heart disease requires complete anatomic definition and timely surgical intervention. Preoperative anatomic detail is enhanced by coordination of different imaging disciplines. Precatheterization cardiac ultrasound avoids unnecessary catheter manipulation, excess radiation and reduces contrast volume. Detailed noninvasive imaging, coupled with an understanding of the natural history and surgical alternatives, obviate the need for preoperative cardiac catheterization in selected lesions. Cardiovascular anomalies which, in a well defined set of circumstances, may be exclusively managed by two-dimensional echocardiography include sinus venosus and secundum type interatrial septal defects, severe aortic stenosis in infancy, and hypoplastic left heart syndrome. The "well defined set of circumstances" are particular to each lesion and must include the patient's history, physical examination, electrocardiogram, and chest X-ray. Definitive management of a cardiovascular anomaly entails consideration of the relative superiority and cost benefit advantages of the different imaging disciplines.