[Problems of non-invasive diagnosis of congenital heart defects in adulthood]

Non-invasive assessment of adult congenital heart disease comprises Doppler echocardiography and magnetic resonance imaging (MRI). Doppler echocardiography represents the modality of choice to perform serial follow-up and MRI is used as supplementary method in the diagnosis of congenital heart disease in adults. The spectrum of congenital heart disease in adults encompasses (a) uncorrected and newly detected defects; (b) palliatively corrected and totally corrected defects. In general, diagnostic modalities must be able to fulfill the following requirements: (a) sequential morphologic analysis; (b) assessment of hemodynamics. Sequential morphologic analysis using 2-dimensional echocardiography includes determination of the situs of the atria, atrio-ventricular and ventriculo-arterial connections. Non-invasive assessment of hemodynamics is performed with the Doppler technique and comprises diagnosis and quantitation of (a) (residual) shunt lesions, (b) valvular regurgitation and (c) valvular, subvalvular, supravalvular and infundibular stenosis as well as pressure gradients across anastomoses and intracavitary or intercavitary gradients, respectively. Pulmonary vascular resistance cannot be assessed quantitatively by Doppler. However, the determination of the end-diastolic gradient between the pulmonary artery and the right ventricle in the presence of pulmonic regurgitation allows estimation of the diastolic pulmonary artery pressure.