This panel discussion will focus on the echocardiographic assessment of adults with congenital heart disease (ACHD). Panelists will explore how congenital lesions and surgical repairs alter conventional imaging strategies, with particular emphasis on recognising residual shunts and avoiding common diagnosis pitfalls.
The session will address practical challenges and strategies for optimising acoustic windows in patients with suboptimal imaging conditions. Discussion will extend to the evaluation of complex haemodynamic flow patterns, with a focus on accurately quantifying pressures and gradients in patients with multi-level obstructions or unconventional flow pathways. The panel may also discuss right-sided imaging challenges in ACHD and consider the role of emerging technologies in complex congenital anatomy.
The panel also hopes to address the evolving training needs for sonographers managing complex AVHD studies, highlighting skills required to safely and confidently perform comprehensive assessments in this growing patient population.

Introduction: Exercise-induced cardiac remodelling (EICR) is a physiological adaptation to chronic exercise but can overlap with pathological phenotypes. Ultramarathon swimming presents a unique physiological stimulus; however, cardiac adaptation in this cohort remains unexplored. This study aimed to describe cardiac structure and function in ultramarathon swimmers, comparing findings with contemporary clinical reference ranges.
Methods: Ninety-one marathon-trained swimmers (age 39±12 years; 52% female) underwent comprehensive 2D and 3D transthoracic echocardiography including left (LV) and right ventricular (RV) morphology, diastolic function, biventricular systolic function, and myocardial global longitudinal strain (GLS). Measures were compared to age- and sex- adjusted reference ranges.
Results: Normal LV geometry was observed in 54% of swimmers. LV hypertrophy was present in 26% (21% eccentric, 5% concentric), while concentric remodelling was identified in 20%. Indexed LV end-diastolic volumes exceeded reference values in 58% of swimmers, decreasing to 45% following age-adjustment, and to 7% when assessed using 3D LV volumes. RV dimensions exceeded clinical thresholds in 16% of swimmers. Systolic function was below reference values in 4% by RV GLS, and 11% by LV GLS; however, all participants were within references ranges when assessed using 3D LV GLS.
Conclusion: Ultramarathon swimmers demonstrate cardiac adaptation beyond standard reference ranges. Application of age- and sex-matched normative data and detailed 3D assessment confirms preserved cardiac function and aids in differentiating physiological adaptation and pathology.
Take home message: EICR is prevalent in ultramarathon swimmers, highlighting the importance of distinguishing between physiologic adaptation from pre-clinical pathology to avoid misclassification.

Congenital heart disease can be full of surprises, and echocardiography often provides the first glimpse into these cardiac curiosities. "A Case of Mistaken Identity" explores a spectrum of congenital heart anomalies encountered on echocardiography, using real clinical cases to uncover the subtle imaging clues that can reveal clinically significant anomalies hiding in plain sight. This presentation offers a visual and practical journey through difficult echocardiographic findings, highlighting key imaging techniques, interpretive strategies, and common pitfalls to help clinicians recognise and correctly identify these remarkable congenital variations.

In this hands-on scanning shop we’ll focus on how to assess the right heart chambers including new considerations from the 2025 Update: Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography.

In this hands-on scanning shop we’ll focus on how to assess the right heart chambers including new considerations from the 2025 Update: Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography.