Clinical applications of real-time two-dimensional scanning in congenital heart disease

Real-time two-dimensional echocardiography (cross-sectional ultrasound scanning with rapid frame rates) for noninvasive imaging of cardiac spatial anatomy has had a major impact in pediatric cardiology. Since most serious forms of congenital heart disease represent gross spatial alterations in cardiac anatomy, the two-dimensional real time imaging capabilities of these systems have proven a special worth in the presence of complex congenital heart lesions which are often quite difficult to assess using single crystal 'flashlight beam' techniques of echocardiography. Major advantages of these real-time systems are (1) ease of spatial orientation, (2) the visualization of structure motion as an aid to structure identification, and (3) the availability of selected M modes with a known spatial orientation from within the cross-sectional image. The latter feature has increased the accuracy of dimensional determinations in small hearts and has led to a better understanding of the determinants of the time-motion echocardiogram. The authors review some of the major clinical applications of cross-sectional echocardiography in congenital heart disease.