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Echocardiography for the neonatologist. Part 2. Structural and transitional haemodynamic problems in the newborn. Practical
  1. C Wren

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This second CD, covering structural and transitional haemodynamic problems in the newborn, is the companion volume to part 1, which dealt with normal 2D imaging and Doppler. In this latest volume, the authors deal comprehensively with the use of echocardiography in the diagnosis and assessment of preterm patent ductus arteriosus, pulmonary hypertension, and low output states. They also provide an introduction to recognition of structural cardiovascular malformations.

The CD is divided into six sections that deal, respectively, with the ductus arteriosus, atrial shunting, measurement of flow and ventricular output, assessment of ventricular function and hypertrophy, measurement of pulmonary artery pressure, and an introductory description of common types of cardiovascular malformation. Images are mainly provided as a mixture of text and video clips.

The first section on patent ductus arteriosus is excellent, providing many examples of the diagnosis and assessment of functional importance. The section on measurement of pulmonary artery pressure provides a valuable insight into one of the more important applications of cardiac ultrasound in neonatology. The sections on atrial shunting, flow measurement, and assessment of ventricular function cover applications of cardiac ultrasound that are likely to be less familiar to most neonatologists and will require more assimilation. The final section, on structural congenital heart disease, is really only an introduction to what is obviously a very large subject. The authors stress that suspicion or confirmation of a cardiovascular malformation should lead directly to a cardiological referral and they highlight the difficulty in exclusion or confirmation of some diagnoses, particularly total anomalous pulmonary venous connection and coarctation of the aorta. Some of the examples of cardiovascular malformations are of rather disappointing quality and some of the more difficult problems, such as coarctation of the aorta, are dealt with only very briefly. There is also possible confusion between coarctation of the aorta and interruption, which cardiologists regard as different abnormalities. The self assessment section offers the opportunity of testing your skills in recognition of various examples but there is no leeway in terminology. For example, TAPVC (connection) is counted as a wrong answer for TAPVD (total anomalous pulmonary venous “drainage”).

Overall this is a valuable guide to the way in which neonatologists should use echocardiography and what they should expect to be able to achieve. I think it is likely to be of more use than a textbook as echocardiography is mainly about interpretation of moving images. Details of both CDs are available at

Supplementary materials

  • CD Review
    Author of Review: C Wren

    Echocardiography for the neonatologist. 
    Part 2. Structural and transitional haemodynamic problems in the newborn. Practical
    N Evans, G Malcolm

    Author's Correction

    Please note that the affiliation of the authors is published incorrectly. This should have read
    Royal Prince Alfred Hospital, Sydney

    Also, the web address in the final paragraph is incomplete. The correct address is:

    The errors are much regretted

Linked Articles

  • Correction
    BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health