Changing role of non-invasive investigation in the preoperative assessment of congenital heart disease: a nine year experience.

Abstract

The total surgical experience of a supraregional paediatric cardiology unit over a nine year period (January 1980 to December 1988) was reviewed to assess the effect of the introduction of the full range of ultrasound techniques. A total of 1517 patients underwent cardiac surgery (955 cardiopulmonary bypass, 562 closed procedures). Of these, 485 patients (32%) did not undergo cardiac catheterisation before operation: 217 bypass (23% of all procedures under cardiopulmonary bypass) and 268 closed procedures (48%). The overall ratio of catheterisations to operations for patients undergoing palliative or corrective surgery fell from 0.97 (1980) to 0.38 (1988). The patients were classified as (a) neonates (0-28 days), (b) infants (one to 12 months), and (c) children (one to 14 years). The main impact of non-invasive surgical referral was in neonates (total catheter:operation ratio 0.38; neonates 0.2 for 1988). The surgical population was further divided according to the principal echocardiographic technique available: (a) 1980-4 cross sectional imaging; (b) 1985-6; imaging plus spectral Doppler ultrasound; (c) 1987-8; imaging plus spectral Doppler ultrasound and colour flow mapping. A fall in the catheter:operation ratio for all age groups was most pronounced in the last four years. This reflects increased familiarity and surgical confidence with non-invasive diagnostic assessment. The introduction of each new echocardiographic technique was associated with a significant fall in the total catheter:operation ratio compared with the preceding period. Six incorrect ultrasound diagnoses were made during the entire period; one of these patients died in the early postoperative period. The integration of Doppler ultrasound with cross sectional imaging has made non-invasive assessment an increasingly practical alternative to preoperative cardiac catheterization.

Do We Need More Than a Transthoracic Echocardiography When Evaluating Children with Congenital Heart Disease before Cardiac Surgery?

“…In the past three decades, echocardiography has been the noninvasive imaging modality of choice for diagnosis and follow‐up of children and adults with CHD . Our study confirms that a TTE can be used as the sole diagnostic imaging modality to evaluate children with CHD undergoing cardiac surgery after a comprehensive evaluation of clinical, anatomic, physiologic, and social factors, among others, has been conducted.…”

Seven-Year Experience of Noninvasive Preoperative Diagnostics in Children with Congenital Heart Defects: Comprehensive Analysis of 2,788 Consecutive Patients

“…Subsequently, several other pa pers have been published on noninvasive diagnostics and its impact on surgical results only in selected patients or over a short period of time [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27], Echocardiographically based surgery in individual patients was reported in Fallot's tetralogy [28,29], anomalous origin of the left cor onary artery from the pulmonary artery [30], pulmonary sling [31] and ASD [32], All these studies of noninvasive preoperative assessment in children with CHD were, however, retrospective and restricted to small numbers or selected groups of patients. There is only one long-term regional experience of noninvasive preoperative manage ment prior to surgery for CHD reported from Wessex (UK) by Sreeram et al [33]. The paper retrospectively analyzed the effect of the introduction of the full range of ultrasound techniques with 32% of 1,517 patients who did not undergo cardiac catherterization before surgery.…”

Pediatric Cardiac Surgery with Echocardiographic Diagnosis Alone

“…However, cardiac catheterization, especially in neonates and small infants, carries a risk. Recent technical advances in echocardiography provides the information needed for a safe cardiac surgery in many patients without invasive catheterization (1)(2)(3)(4)(5)(6). Initially, this exclusively echocardiography-based diagnostic approach has been applied to simple cardiac defects (7)(8)(9)(10) and functional single ventricle defects requring palliative surgery (11,12); in recent years, even complex lesions were proven to be adequately defined for surgical repair by non-invasive echocardiographic evaluation alone (13)(14)(15)(16)(17)(18).…”