This study was designed to compare imaging characteristics and diagnostic criteria for cross-sectional echocardiography in 55 children (aged six months to 19 years) with documented forms of complex congenital heart disease who were studied using two different echocardiographic imaging systems: (1) a real-time multiple crystal, cross-sectional echocardiographic system and (2) a mechanical sector scanner. Examiners were blind to diagnosis, and images were graded with regards to visualization of great vessel orientation and atrioventricular valve morphology. Cardiac lesions included single ventricle (five children); "corrected" transposition (eight children); d-transposition (three children); Ebstein's malformation (four children); endocardial cushion defect (eight children); and various other malformations (27 children). The multiple-crystal system allowed a larger area of the heart to be visualized at any given time and resulted in a more rapid demonstration of the contour and positional relationships of atrioventricular valves and great arteries. The mechanical sector-scanner visualized a smaller area of the heart at any given time but provided high-resolution images that were particularly useful in analyzing the shape of great arteries and the insertion of the atrioventricular valves. New criteria were developed during the course of the study for analysis of the morphology of the atrioventricular valves based on the appearance of the atrioventricular valve orifice in the transverse plane and the relation of the atrioventricular valve to the atrioventricular septum as visualized with the mechanical sector scanner. The two echocardiographic systems provided complimentary information. The images obtained rapidly with the multiple-crystal system were valuable indicators of areas for further study with the sector scanner. Both systems were powerful tools for the noninvasive evaluation of complex congenital heart disease.
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