Basic Evaluation of Grown Up Congenital Heart Disease (GUCH)/Adult Congenital Heart Disease (ACHD)

Basic evaluation of grown up congenital heart disease (GUCH)/adult congenital heart disease (ACHD)

Evaluation of a patient with grown up congenital heart disease (GUCH)/adult congenital heart disease (ACHD) is similar to any other patient and begins with a good history to assess the present and past symptoms. Intercurrent events have to be noted as well as any previous need for changes in medication. Changes in lifestyle and daily activity will be helpful in assessing disease progression. Clinical evaluation would include documentation of blood pressure, auscultatory findings and any signs of heart failure. This is important for follow up evaluations. Routine electrocardiogram and pulse oximetry are done in the hospital setting. Chest x-rays, though not routinely indicated now, is often useful in the documentation of cardiac size, configuration and pulmonary vascularity which is helpful during long term follow up.

Echocardiography is currently the most important investigation in GUCH/ACHD. Cardiac anatomy including position, orientation, sequential chamber analysis (venous return, atrioventricular relationship and ventriculo arterial relationship) are documented with echocardiography, it may be quite a time consuming process in complex congenital heart diseases. But in GUCH/ACHD, the number of possibilities become limited due to the natural attrition of some of the more complex varieties which could be seen in early infancy. Cardiac chamber morphology and function, valvular morphology and function as well as shunt lesions can be quantified by echocardiography. Quantification of transvalvar flows and gradients can be done with Doppler echocardiography. Difficulties in assessment of ventricular volumes may be experienced in complex anatomies. Doppler gradients can be erroneous when the alignment of the jet is inaccurate and in case of stenoses in series. In certain cases great vessels may not be imaged well and so may be the venous return.