Patient Care, Image Acquisition Protocols, and Post-Operative/Surgical Assessment
Patient care and acquisition
Children need warmth, a quiet environment, and a parent present; feed-and-swaddle works for infants, and sedation decisions follow institutional protocols with monitoring. Use age-appropriate ECG and blood pressure cuffs, and keep the examination efficient because tolerance is limited. Image in the standard windows - subcostal, apical, parasternal, suprasternal - and always perform a complete segmental sweep rather than chasing a single finding. Optimize frame rate by narrowing the sector, and use higher-frequency probes for small patients. Document z-scores for chamber sizes and great-vessel dimensions, and note the phase of respiration for venous and inflow measurements.
Post-operative assessment
Norwood stage I is either a modified Blalock-Taussig shunt or a Sano (RV-to-PA conduit); the shunt is the vulnerable structure - assess patency by 2D and color, and remember that a shunt gradient is expected and not equivalent to stenosis. Bidirectional Glenn (superior cavopulmonary) flow is passive and low velocity, so high-velocity or turbulent flow suggests obstruction. Fontan circulation has low-velocity passive flow; a fenestration should show right-to-left flow, and any measurable gradient across the pathway is abnormal. After arterial switch, watch for neo-aortic root dilation, supravalvar pulmonary stenosis at the anastomoses, and coronary patency. After tetralogy repair, expect residual pulmonary stenosis or free regurgitation with RV dilation. After Mustard or Senning, look for baffle obstruction or leaks. Always survey for pericardial effusion, ventricular dysfunction, and arrhythmia-prone states such as junctional ectopic tachycardia after tetralogy repair.
Rule of thumb: in a post-operative patient, measure gradients across every anastomosis and never assume a shunt is patent because flow is audible.