Pearls
- The RV is recognized by its morphological features and not by its location (e.g. in ccTGA, the RV is on the left)
-If a shunt is suspected and not demonstrated on TTE, pursue contrast imaging or magnetic resonance imaging
- Always assess coronary anatomy if a patient is deteriorating or before a corrective surgery e.g. in TOF or TGA post arterial switch
Always exclude associated congenital heart defects
- Atrial arrhythmias or ventricular tachycardia often indicate severe hemodynamic compromise and should lead to further assessment
- Always consider protein losing enteropathy in the presence of hypoalbuminemia
- Close monitoring of patients with RV failure is needed to find the proper window for surgery (cf. table on indications) |
Pitfalls
- Never attempt to close a septal defect in the presence of severe “irreversible” PH
- Never manage complex congenital cases without referral to a regional referral center of CHD
- Avoid maximal exercise testing in a patient with severe PH and RV failure (context of ASD or VSD)
- Avoid cardiac catheterization in patients with mild disease or if surgery is not planned.
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