The usefulness of echocardiography in the surgical management of infants with congenital heart disease

Abstract

The Children's Heart Center, Atlanta, 83 infants with congenital heart defects were diagnosed by echocardiography and underwent surgery without cardiac catheterization. The diagnostic categories included 46 infants with left heart obstructive lesions, 19 infants with cyanotic heart lesions, and 18 infants with miscellaneous lesions. Fortyfive infants (55%) underwent surgery under cardiopulmonary bypass. There were three errors in diagnosis, yielding a diagnostic accuracy of 95%. Many infants with congenital heart disease can be accurately and completely diagnosed by echocardiography and can safely undergo surgery without cardiac catheterization. upright imaging. The latter has permitted echocardiography-angiography-heart specimen correlation and has thereby greatly enhanced appreciation of echocardiography.Similarly, at The Children's Heart Center, the credibility of echocardiography was established by extensive angiography+chocardiography correlation. Referral of selected patients to surgery with an echocardiographic diagnosis followed. This proved to be successful, and as our confidence increased a great variety of lesions were submitted for surgery. Currently, echocardiography is used reliably in our institution to make a complete and categorical diagnosis of structural congenital heart disease.In this report we describe our experience with use of echocardiography in the surgical management of patients with congenital heart disease. Key words: echo, congenital infant heart surgery Methods IntroductionSince the early 1980s, several centers1-' have reported successful submission of patients with congenital heart defects to surgery based on echocardiographic diagnosis. This has been possible due to many factors including (a) application of segmental approach to obtain complete anatomical diagnosis, (b) delineation of hemodynamics by pulse wave, continuous wave, and color flow Doppler, and (c) On review of the surgical records between January 1988 and August 1991 of the Emory Department of Cardiothoracic Surgery, 83 infants under 6 months were identified as having had cardiac surgery based on echocardiographic diagnosis. These infants had previously undergone exhaustive echocardiograms using orthogonal sweeping techniques from subcostal, parasternal, and suprasternal windows. A complete anatomical diagnosis was sought in each by employing the segmental approach. All relevant hemodynamic information was obtained by pulse wave, continuous wave, and color flow Doppler. Appropriate measurements of chambers and great vessels was made from the two-dimensional image. The studies were stored on 1/2" VHS tapes and reviewed collectively by the echocardiologist, the attending cardiologist, and the surgeon. The patients were referred for surgery only when a complete anatomical diagnosis and relevant hemodynamic and functional information had been obtained to the satisfaction of the reviewers. Frequently, echocardiograms were repeated for clarification or for obtaining additional information. If, however, any uncertainty exis...

Diagnostic accuracy of paediatric echocardiograms interpreted by individuals other than paediatric cardiologists

“…This is in contrast to the error rate of 3% in our controls, none of which impacted at all on patient management. This too is in keeping with the accepted more recently published error rates of 2% 3 …”

“…This too is in keeping with the accepted more recently published error rates of 2%. 3 Failure to recognize an abnormality did not protect against major cardiac disease. Four of eight patients found to have normal external echocardiograms required cardiac surgery or interventional cardiac catheterisation.…”

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).…”

Left Ventricular Outflow Tract Obstruction

“…Echocardiography and Doppler flow studies are extremely informative noninvasive studies that can greatly facilitate the management of congenital heart disease [15]. In addition to establishing the anatomic diagnosis, echocardiography can assess ventricular function, the presence or absence of endocardial fibroelastosis, as well as associated cardiac anomalies [12].…”