Echosonographers: Are you terrified to learn congenital heart defects?

There is no doubt that this is an intimidating subject; There are some sonographers I have talked to in the past who have actually told me that they would rather quit their jobs than to start doing pediatric echos!

The problem is that adult congenital heart defect patients who have had surgeries going back to the 70’s are now beginning to show up in adult echo labs. Sooner or later, sonographers will have to learn this subject and at least be competent enough to provide a basic echocardiogram that is readable for a pediatric cardiologist.

There are currently about a million adults in the USA alone who have had pediatric heart surgery.

This has spawned a new industry in the medical field that has led to a fusion of adult and pediatric echocardiography. There are clinics popping up everywhere that treat these patients and have on staff both adult and pediatric cardiologists. The primary reason that these people are showing up is that many of these defect repairs are not permanent, and many people are now suffering from problems such as congestive heart failure and now need further treatment.

As a sonographer in one of these institutions, it is up to you to be able to not only image these surgical corrections and perform a competent echocardiogram, but to identify the original defect.

Many of these patients only know that they had a defect repaired early in childhood, but have no idea what their original defect was or what kind of surgery they had. On the other hand, some of these patient are quite sophisticated and have extensive knowledge about congenital heart defects.

A significant number of these patients no longer go to a Children’s Hospital and may show up in your adult lab. In the end, if you are a sonographer of any kind, it will be in your best interest to start learning this subject now.

Fortunately, there is an easier way to learn this complicated subject. This blog is an extremely good beginning. Start by reading my posts on embryology and morphology. It is extremely important that the sonographer understand how and why these defects develop. (use the search tool on the right to access these posts easily).

Secondly, read my posts on “the segmental approach to pediatric cardiology”. The segmental approach divides the heart into sections, and then requires the sonographer to evaluate and describe each section in detail.

The sections are: the atrial mass, the ventricular mass, the atrioventricular valve apparatus (or AV connections), the truncal mass (or ventriculo-arterial connections), and the veno-atrial connections (vena cavae and the pulmonary veins).

It is important to approach the heart in this way. Keep in mind that the heart is composed of four chambers, four valves and eight blood vessels that run in and out of the heart.

During fetal development, anything may happen to these connections, and many of these defects overlap with each other. To this day, there is much controversy on how to classify and name these defects with all of their sub-classifications and permutations.

This is especially true when you cross borders and continents, for example, Europe and Canada to the USA, as well as Asia.

Finally, read the post on “how to do a pediatric echo”

The worst way to approach this subject is to try to memorize each defect (there are at least 30 major defects and many sub-defects). As an echocardiographer, it is up to you to describe the various connections involved in each defect rather than to try to name the defect. It is up to the pediatric cardiologist to actually name the defect.

For instance, the echocardiographer may write in the worksheet something like ” concordant atrioventricular connections, discordant ventriculo-atrial connections and concordant veno-atrial connections”.

In other words, a D-transposition of the great vessels. It is up to the reading cardiologist to make the definitive diagnosis and name the actual defect.

In summary, it is a good idea for the sonographer to fully read the posts on this blog. Further, it is a good idea to read the book “Congenital Heart Defects, Simplified”, and keep this book with you whenever you scan. This book is 105 pages long, and itemizes each defect in a two page format with diagrams (including surgical repairs) on the right, and bullet point descriptions on the left. It is a durable spiral bound book that allows easy and quick access to any defect you may encounter.

This book starts at the very beginning and describes the normal heart, and progresses to the most complex and difficult defects. Everything is in alphabetical order and most of the information one may need is included in the two page format.

The appendix is especially valuable, and includes subjects such as a summation of the surgical repairs (in alphabetical order), typical functions and values, scanning protocols, imaging tips, a worksheet and a complete glossary.

This blog nicely augments all of the information found in the book, and provides the most up-to-date information available.

 I use as my primary resource the book “Paediatric Cardiology” (British spelling), by Robert Anderson M.D. et al, one of the most respected cardiologists in both the USA and Europe. This 1400 page book (third edition) was published in 2010 by Elsevier Publishing, and is the go to book for todays pediatric cardiologists.

My book “Congenital Heart Defects, Simplified” is a home study course that includes a 300 question registry review, a test available and graded in an online format, excellent for students and experienced sonographers alike. 30 SDMS CME’s are awarded for completion of this course.

Please use the link on the right of this blog, or go to “HeartDefectsSimplified.com”.

To contact me, go to the contact section of the website.

Thank You

Ken Heiden RDCS, RVT