Changing role of non-invasive investigation in the preoperative assessment of congenital heart disease: a nine year experience.
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.
Sreeram
N
N
Wessex Regional Cardiothoracic Centre, Southampton General Hospital.
Colli
A M
AM
Monro
J L
JL
Shore
D F
DF
Lamb
R K
RK
Fong
L V
LV
Smyllie
J H
JH
Keeton
B R
BR
Sutherland
G R
GR
D000293:Adolescent; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D003951:Diagnostic Errors; D004452:Echocardiography; D015150:Echocardiography, Doppler; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies