In this book an overview is given of the many new problems facing the adult and pediatric cardiologist as well as the cardiac surgeon in this rapidly increasing subgroup of the adolescent and adult cardiac population. The various authors describe the challenges, controversies, uncertainties and questions involved with treatment of this particular group of patients. "Congenital Heart disease in Adolescents and Adults" is of value to both the adult and pediatric cardiologist and other colleagues, who have to undertake the care of these patients, whose management poses such unique problems.

In May 1990, the First International Symposium on Congenital Heart Disease in Adolescents and Adults was organized in Rotterdam. During these three days' Symposium an overview of the many new problems facing the adult and pediatric cardiologist as well as the cardiac surgeon in this rapidly increasing subgroup of the adolescent and adult cardiac population was given. Chal­ lenges, controversies, uncertainties and questions were presented and discussed with great enthusiasm. We are greatful that most speakers who participated in this symposium, were willing to write a chapter on their presented topics to be edited in book-form. The final result is here. We hope, it will be of value for both to the adult and pediatric cardiologist and other colleagues, who have to undertake the care of this group of patients, whose management poses such unique problems. J.H. G.S. ix 1. The problem - an overVIew JANE SOMERVILLE The subject of grown-up congenital heart disease is currently and correctly attracting attention in the world. Surgical treatment for congenital heart disease (C.H.D) has evolved through the last 40 years, starting with the attempts by Blalock and Brock to palliate, to the current refined technical virtuoso repairs of the most complex in infancy.

The noninvasive evaluation of hemodynamics in congenital heart disease is an application for which Doppler ultrasound is ideally suited. The pediatric cardiac sonographer has used 2D and TM imaging for several years to study the structural abnormalities associated with various lesions. Pulsed Doppler, continuous wave Doppler, and more recently, color flow mapping techniques have been used to study the pathophysiology, and to make quantitative measurements thereof. To those already working in pediatric echocardiography, this book is intended to serve as a guide to the applications of the various Doppler modalities in specific abnormalities. The other group for which this text is intended are the adult cardiac sonographers who see the occasional patient with congenital heart disease in their echocardiography laboratories. The incidence ofcongenital heart disease is not decreasing. As more patients survive to child bearing age, the adult cardiologist sees more and more referrals from the pediatric cardiologist to follow up the parent with corrected congenital heart disease, and in many smaller institutions, to examine their offspring as well. For this group, the book is intended to serve as a reference which gives a basic description of the pathology, the relevant parameters to observe, and a guide to the Doppler applications used to make these observations. While there are a few books available on the subject of echocardiography in congenital heart disease, they do not usually go into much detail on noninvasive assessment of the pathophysiology. It is our hope that this text fills that gap.

In this book an overview is given of the many new problems facing the adult and pediatric cardiologist as well as the cardiac surgeon in this rapidly increasing subgroup of the adolescent and adult cardiac population. The various authors describe the challenges, controversies, uncertainties and questions involved with treatment of this particular group of patients. "Congenital Heart disease in Adolescents and Adults" is of value to both the adult and pediatric cardiologist and other colleagues, who have to undertake the care of these patients, whose management poses such unique problems.

In May 1990, the First International Symposium on Congenital Heart Disease in Adolescents and Adults was organized in Rotterdam. During these three days' Symposium an overview of the many new problems facing the adult and pediatric cardiologist as well as the cardiac surgeon in this rapidly increasing subgroup of the adolescent and adult cardiac population was given. Chal­ lenges, controversies, uncertainties and questions were presented and discussed with great enthusiasm. We are greatful that most speakers who participated in this symposium, were willing to write a chapter on their presented topics to be edited in book-form. The final result is here. We hope, it will be of value for both to the adult and pediatric cardiologist and other colleagues, who have to undertake the care of this group of patients, whose management poses such unique problems. J.H. G.S. ix 1. The problem - an overVIew JANE SOMERVILLE The subject of grown-up congenital heart disease is currently and correctly attracting attention in the world. Surgical treatment for congenital heart disease (C.H.D) has evolved through the last 40 years, starting with the attempts by Blalock and Brock to palliate, to the current refined technical virtuoso repairs of the most complex in infancy.

The noninvasive evaluation of hemodynamics in congenital heart disease is an application for which Doppler ultrasound is ideally suited. The pediatric cardiac sonographer has used 2D and TM imaging for several years to study the structural abnormalities associated with various lesions. Pulsed Doppler, continuous wave Doppler, and more recently, color flow mapping techniques have been used to study the pathophysiology, and to make quantitative measurements thereof. To those already working in pediatric echocardiography, this book is intended to serve as a guide to the applications of the various Doppler modalities in specific abnormalities. The other group for which this text is intended are the adult cardiac sonographers who see the occasional patient with congenital heart disease in their echocardiography laboratories. The incidence ofcongenital heart disease is not decreasing. As more patients survive to child bearing age, the adult cardiologist sees more and more referrals from the pediatric cardiologist to follow up the parent with corrected congenital heart disease, and in many smaller institutions, to examine their offspring as well. For this group, the book is intended to serve as a reference which gives a basic description of the pathology, the relevant parameters to observe, and a guide to the Doppler applications used to make these observations. While there are a few books available on the subject of echocardiography in congenital heart disease, they do not usually go into much detail on noninvasive assessment of the pathophysiology. It is our hope that this text fills that gap.