Echocardiography in the Adult with Congenital Heart Disease

The past 50 years of medical science have been witness to a profound revision in the natural history of those born with congenital heart disease. Improved understanding of anatomy, embryology, and natural history; expansion of the diagnostic modalities applicable to these patients; and advances in surgical and catheter-based interventions of these diseases have resulted in a growing population of patients who have survived to adulthood. Currently more than 500,000 such adults are alive in the United States. Additionally, in the United States alone 25,000 infants with congenital heart disease are born annually. Twenty thousand of these patients will undergo surgery. Between 23,000 and 24,000 of these patients will survive to adulthood.’ Hence, what was once an obscure entity rarely seen by the medical cardiologist is becoming a significant clinical problem. As an example, a greater proportion of expectant mothers seen at some high risk obstetrical centers are now affected by congenital heart disease rather than by valvular heart disease.'^^ Given this growth in numbers, it is important that echocardiographers seeing adult patients better familiarize themselves with congenital heart disease. In 1993, this requires familiarization not only with those lesions more likely to first present in adulthood, e.g., coarctation of the aorta and atrial septa1 defect, but also less common entities that have previously undergone surgical repair, e.g., te-