Transthoracic echocardiography (TTE) is the first-line tool for diagnosis and followup of pediatric and young adult patients with congenital heart disease (CHD). Appropriate use of TTE can reduce the need for more invasive modalities, such as cardiac catheterization and cardiac magnetic resonance imaging. New echocardiographic techniques have emerged more recently: tissue Doppler imaging, tissue tracking (strain and strain rate), vector velocity imaging (VVI), myocardial performance index, myocardial acceleration during isovolumic acceleration (IVA), the ratio of systolic to diastolic duration (S/D ratio), and two dimensional measurements of systolic right ventricular (RV) function (e.g., tricuspid annular plane systolic excursion, TAPSE). These may become valuable indicators of ventricular performance, compliance, and disease progression. In addition, three-dimensional (3D) echocardiography when performed for the assessment of valvular function, device position, and ventricular volumes is being integrated into routine clinical care. In this paper, the potential use and limitations of these new echocardiographic techniques in patients with CHD are discussed. A particular focus is on the echocardiographic assessment of right ventricular (RV) function in conditions associated with increased right ventricular volume (e.g., pulmonary regurgitation after tetralogy of Fallot repair) or pressure (e.g., pulmonary hypertension) in children and young adults. 1. Introduction Echocardiography has become the most important and routinely applied noninvasive imaging technique for the diagnosis and followup of patients with congenital heart disease (CHD). Cross-sectional Doppler echocardiography allows a detailed description of cardiovascular anatomy, ventricular, and valvular function. The diagnostic accuracy for describing cardiac morphology is very high, with a reported incidence of less than 100 errors in more than 50.000 echocardiograms [1]. Most functional variables used in echocardiography were developed and validated for the assessment of the normal, systemic, morphologically left ventricle (LV). The heterogeneity of CHD, anatomic normal variants, effects of the child’s growth, and interstudy variability of hemodynamics complicate the proper interpretation of many functional variables. For the LV, adult techniques are often extrapolated to pediatrics without comprehensive validation in a large pediatric cohort or even blinded prospective studies. For the RV, qualitative (subjective) assessment is the technique used routinely in most laboratories (eye balling).
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