[Color flow mapping 2-D Doppler in determining surgical indication for congenital heart disease].
Real-time two-dimensional Doppler echocardiography (2-D Doppler) is established as an effective diagnostic tool for cardiovascular diseases. However, in determining indications for surgery of congenital heart disease (CHD), the possibility of avoiding preoperative cardiac catheterization including radiographic angiography, has not been fully discussed since the clinical introduction of 2-D Doppler. We evaluated 278 patients with CHD by 2-D Doppler including ASDs (75 patients), VSD (76 patients), TOF (23 patients), TGA (12 patients), PDA (23 patients), ECD (13 patients), and 60 miscellaneous types of CHD during 27 months. The diagnosis of the 278 patients were confirmed by catheterization and/or surgery. Of these, 114 patients underwent corrective surgery (83 patients) or palliative procedures (31 patients). Preoperative cardiac catheterization was performed for 88 patients (Group A), and omitted in 26 patients (Group B). The 2-D Doppler diagnosis was correct in 79 patients of Group A (89.8%) and in 26 patients of Group B (100%). The surgical procedures scheduled according to the preoperative 2-D Doppler diagnosis were performed for these 105 patients (92.7%) without any corrections by cardiac catheterization diagnosis or by surgical findings. However, 2-D Doppler failed to establish the preoperative diagnosis for six patients in Group A (two patients with ASD, three with PDA, and one with TOF) and failed to detect associated cardiac abnormalities for three patients in Group A (two with PAPVC, one with Azygos connection). Results of this study suggest that preoperative cardiac catheterization could be omitted in a maximum of about 90% of surgical candidates with CHD. However, to omit cardiac catheterization 2-D Doppler echocardiographic criteria for indications for surgery in each group of CHD must be established, and any associated coronary artery abnormalities must be ruled out.
D000328:Adult; D006328:Cardiac Catheterization; D002648:Child; D015150:Echocardiography, Doppler / Q000379:methods; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007223:Infant; D011237:Predictive Value of Tests; D011300:Preoperative Care