Reappraisal of the approach to the child with heart murmurs: is echocardiography mandatory?
The performance of cross-sectional echocardiography on every child with a heart murmur poses a heavy load and economic burden on pediatric cardiology services. We prospectively studied 100 consecutive patients newly referred to our clinic for evaluation of a heart murmur. After a thorough clinical assessment and review of the electrocardiogram and chest radiograms, 50 patients were diagnosed as having "innocent murmurs". Cross-sectional echocardiography confirmed the initial diagnosis in 48 patients (96%). Two patients had bicuspid aortic valve. Among the patients with echocardiographically proved innocent murmur, left ventricular anomalous bands were demonstrated in 15 patients (31%), right ventricular anomalous bands in 5 patients (10%) and increased left ventricular shortening fractions (greater than or equal to 0.5) in 10 patients (21%). Among the remaining 50 patients, the initial diagnosis was "suspected heart disease" in 10 patients, and "pathological murmurs" in 40 patients. Cross-sectional echocardiography was most useful in these patients providing the diagnosis in 80% (eight) of the former group and 95% (38) of the later group. Echocardiography need not be routinely performed in children initially diagnosed, by a pediatric cardiologist, as having an "innocent murmur".
Geva
T
T
Department of Pediatrics C, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Hegesh
J
J
Frand
M
M
D000293:Adolescent; D001024:Aortic Valve Stenosis / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000175:diagnosis; D004452:Echocardiography; D005260:Female; D006326:Heart Auscultation / Q000145:classification*; D006337:Heart Murmurs / Q000145:classification*; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis; D006345:Heart Septal Defects, Ventricular / Q000175:diagnosis; D006801:Humans; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011666:Pulmonary Valve Stenosis / Q000175:diagnosis; D013771:Tetralogy of Fallot / Q000175:diagnosis