Evolution of echocardiography in neonatal diagnosis

In the late 1960's, Edler and Lundström introduced ¿ultrasoundcardiography¿ for the evaluation of congenital heart disease. Initial evaluations using A- and M-mode echocardiography produced non-invasive diagnosis of many defects, including specific complex malformations such as hypoplastic left heart, Ebstein's malformation, endocardial cushion defect and transposition, all with single crystal techniques. Normal values for dimensions related to patient size and indices of function developed at that time remain as components of contemporary examinations. Two-dimensional imaging technology has evolved from 20 channels on Bom's linear array to 128-channel systems currently providing detailed imaging of structures as small as neonatal coronary arteries. The contribution of Doppler techniques for qualitative evaluation of blood flow characteristics has been greatly augmented by both the quantitative Doppler methods for accurate assessment of pressure gradients and pulmonary pressure, and by the development of color Doppler display of intracardiac and intravascular flow. These contributions have come from centers worldwide, with many initial and ongoing contributions from Lund. The evolution of instruments, and of application, now provides neonatal echocardiographic delineation of anatomic detail, function and hemodynamics of sufficient clarity and accuracy to replace the need for invasive study, or alternative technologies, in most cases.