Diagnostik bei kongenitalen Vitien: Stethoskop, Echokardiographie und/oder MRI?

For the cardiac assessment of patients with congenital heart disease, a physical and echocardiographic examination remain compulsory. Additionally, magnetic resonance imaging (MRI), or rarely computed tomography or heart catheterisation may be needed. The physical examination is excellent to assess cyanosis, signs of heart failure or arrhythmias in a fast, cheap and efficient way. Due to the auscultatory findings, diagnosis of underlying valvular heart disease, or eg a ventricular or atrial septal defect is possible. Certain findings of auscultation are very specific such as the diastolic decrescendo murmur of aortic regurgitation, other murmurs are more difficult to be accurately classified such as the hybrid systolic murmur in hypertrophic obstructive cardiomyopathy. Echocardiography is essential to classify situs, levo-, dextroor mesocardia, for the exact identification of structural heart disease, to describe the exact morphology of valves and ventricles, to identify even tiny shunts and to quantify pulmonary artery pressure. Limitations of echocardiography lie especially in the analysis of extracardiac structures where MRI is helpful. The MRI plays an important role in the assessment of the aorta, the right ventricle, the pulmonary arteries, the pulmonary veins, the systemic veins and in any very complex congenital heart disease. Finally, to assess and treat the patient optimally, the cardiologist has to analyse and judge the findings of all the selected investigative procedures, this requires a lot of time and experience.