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Two-dimensional echocardiography in the right oblique subxiphoid view (ROSV) was used to visualize all right ventricular components in 351 patients younger than 2 years of age (100 normal and 251 with various types of congenital heart disease). The ROSV, which is anterior and parallel to the ventricular septum, displays all right-sided cardiac components, the left atrium and the aorta. This view provided the correct diagnosis in patients with pulmonary stenosis or atresia with intact ventricular septum, Ebstein's anomaly, tricuspid atresia, infundibular ventricular septal defect, tetralogy of Fallot and truncus arteriosus. In all patients studied with the ROSV, an excellent definition of morphologic characteristics, equivalent to that in the right oblique axial angiocardiographic view, was achieved. The ROSV should be used routinely to delineate the right ventricular anatomy in all infants with congenital heart disease.

The anatomy of crisscross heart was studied in 14 patients, aged 2 days to 26 years, using 2-dimensional (2-D) echocardiography. The visceroatrial situs was solitus in all 14 patients. Crossing of the atrioventricular (AV) valves could be seen in each case by scanning in a subxiphoid or apical 4-chamber view. The subpulmonary infundibulum was deficient in 13 of the 14 patients, resulting in approximation of the pulmonary and tricuspid valves. Subpulmonary stenosis, seen in 11 patients, resulted from proximity of the infundibular septum, the tricuspid valve and the subpulmonary infundibular free wall. A subaortic infundibulum, present in all cases, was well developed in 13 patients, who had malposition of the great arteries, and was short in 1 patient, with nearly normally related great arteries. In cases that conformed to the inverse loop rule (segmental combination (S,D,L) or (S,L,D)), the pulmonary valve was posterior to the tricuspid valve and wedged between the AV valves. In 3 patients (double outlet right ventricle (S,D,L)) the mitral valve straddled into a large, left-sided subaortic infundibulum. In both patients with arterial malposition who did not follow the inverse loop rule, the pulmonary trunk was anterior to the tricuspid valve and well separated from the mitral valve. In patients with crisscross heart the ventricles appeared to have been rotated about their long axes without concomitant motion of the AV valve anuli, producing actual crossing of the ventricular inflow tracts. The right ventricular sinus was significantly smaller and the infundibulum significantly larger in the patients with crisscross heart than in age-matched control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Subcostal oblique 2-dimensional echocardiography was performed in 64 infants younger than 2 years with complete transposition of the great arteries (TGA) (situs solitus, concordant atrioventricular and discordant ventriculoarterial connections). All patients examined before cardiac catheterization had a correct diagnosis by 2-dimensional echocardiography using the subcostal oblique views. Twelve patients had associated left ventricular (LV) outflow tract obstruction and 7 had right ventricular (RV) outflow obstruction. The standard parasternal views failed to diagnose obstruction in 1 patients with LV outflow obstruction and 5 with RV outflow obstruction; the subcostal left oblique cut and long axis of the left ventricle visualized all left-sided obstructions, and right-sided obstructions were correctly displayed in 5 of 7 cases using a combination of left oblique and right oblique cuts. Two-dimensional echocardiographic subcostal oblique views allow an excellent definition of the morphologic characteristics of RV and LV outflow tracts in patients with TGA and improve the diagnosis of the outflow obstruction in these malformations.