New guidelines for using 3-D echocardiography for patients with congenital heart disease (CHD) released

The European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE) released a new document early in 2017 that provides a comprehensive review of the optimal application of 3-D echocardiography for patients with congenital heart disease (CHD).


Congenital heart disease (CHD) is the most common form of birth defect worldwide, affecting close to 9,900 children born annually in South Africa alone. Currently, in South Africa, only 40% of cases are diagnosed and treated. This leads to the death or disability of as many as 8 children each day, as a result of their CHD (not being treated or diagnosed.

Standard two-dimensional echocardiography, ultrasound of the heart and vascular system, has always been an essential non-invasive diagnostic tool for pediatric cardiologists, but recent advances in technology have led to the increasing importance of three-dimensional echocardiography in this field.

While most parents are quick to ask the gender of their baby during their ultrasounds, many are not equipped to ask the right questions about their baby’s heart. There are 6 essential questions that a parent should be asking when echocardiography is being performed, especially in the third trimester:

1. Do you see four chambers in our baby’s heart?
2. Are there two upper chambers (left and right atria) with valves controlling blood flow into the heart?
3. Are there two lower chambers (left and right ventricles) with valves controlling blood flow out to the body (aortic) and lungs (pulmonary)?
4. Do the two valves and vessels (aorta and pulmonary arteries) exit the heart in a crossing fashion?
5. Are the walls between the lower chambers of the heart intact?
6. Is our baby’s heart normal?

When a possible CHD is diagnosed during an ultrasound, the necessary specialists are consulted before the birth of the child, and they can be present during the birth if it is deemed necessary. Infants with a CHD are completely safe while still in their monther’s womb, but once they are born, they need to be under medical supervision.

Girish S. Shirali, MBBS, FASE of Children’s Mercy Hospital in Kansas City, Mo., wo was ASE’s co-chair on the writing group commented:

“Pediatric cardiology is unique in the wide range of structural abnormalities that we encounter, and for which echocardiography is the most common — and frequently the only — preoperative diagnostic modality that is used. In the absence of clear guidelines for its use, pediatric cardiac centers from a wide range of geographies have developed a wide range of approaches to 3-D echocardiography. This document helps establish a common logic and structure for the display of images, and uses the collective experience of a large group of echocardiographers and sonographers to help develop a common language and approach to 3-D echocardiography. We believe this modality is a powerful addition to the pediatric echocardiographer’s armamentarium, and believe that the current offering will go a long way in enhancing the adoption of 3-D echocardiography for our patients’ benefit.”

Technical considerations and imaging techniques, as well as the value that 3-D echocardiography can add to the management of specific congenital heart defects, are described in detail in this document. The document does not just describe 3-D echocardiography as a diagnostic tool, but it also details the use of 3-D echocardiography to guide catheter-based interventions, which have become increasingly used in recent years, and addresses the need for specific training and educational pathways specific to 3-D echocardiography.

The document entitled: “Three-dimensional Echocardiography in Congenital Heart Disease: An Expert Consensus Document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography,” will appear in the January issue of the Journal of the American Society of Echocardiography (JASE), but is available now online.

Why are documents like this one important? Te researched protocol and detailed guidelines when implemented properly can lead to more accurate diagnosis of possible CHD’s in unborn children, This has a snowball effect as it will automatically increase access to medical treatment and reduce the risk of death or disability as a result of the child’s CHD. It is important for parents to also read these documents and familiarise themselves with the what standards and protocols should be followed.



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