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Introduction: The systemic right ventricle (RV) in congenital heart disease (CHD) is susceptible to progressive dilation and dysfunction. Echocardiographic (2DE) means for serial monitoring of the RV would be of great value in this clinical setting. We utilized 2DE with knowledge-basedreconstruction (KBR), a newly developed tool for volumetric and functional assessment of the RV for evaluation of the systemic RV.Methods: The protocol consisted of patients with transposition of great arteries repaired with an atrial switch and without implanted pacemakers prospectively recruited for same day 2DE-KBR and cardiac magnetic resonance (CMR, 1.5T). RV Images were acquired in various 2D imaging planes using a 3D space localizing device attached to a 3 MHz imaging probe and 3D reconstruction performed using database assistance and dedicated software (Figure). Using the KBR 3D volumetry, Indexed RV end diastolic volume (EDVi),end systolic volume (ESVi) and ejection fraction (EF) were calculated. Volumetric CMR analysis (View Forum, Philips) was used as a reference standard. Mean percentage error (MPE) was used to evaluate intermodality and interobserver reproducibility.Results: Five patients (4 female, 1 male, age 28.5± 10 years) at 27 ± 8 years after atrial switch were studied. 2DE-KBR derived EDVi, ESVi and EF were 119.9 ± 6 ml, 74.2 ± 6 ml, and 38 ± 5% respectively.There was good agreement of 2DE-KBR with the CMR reference; MPE(range) of 7 % (3-11%) for EDV and 10 % (5-15%) for ESV. MPE (range) of 2DE-KBR between observers was 3% (2-5%) for EDV and ESV.Conclusions: We report the first clinical experience with 2DE-KBR in the United States. Preliminary results demonstrate clinical feasibility and good agreement of 2DE-KBR with CMR in the analysis of the systemic RV in adult CHD.