Telemedicine for cardiac surgery candidates.
BACKGROUND
Cardiac surgery is generally well or over-represented in many Western countries. Since the southern part of Switzerland relies on 300 km distance centers for cardiac surgery, we started a project of telemedicine for the distant evaluation of cardiac surgery candidates. We report our experience of the results of the diagnosis made by telemedicine and by direct scrutiny of coronary angiograms.


METHODS
Coronary angiography was performed at the distant hospital by an invasive cardiology team. Teletransmission of images was performed using three Integrated Service Digital Network (ISDN) lines by direct transmission of recent recording. A total of 98 cases were reviewed (87 aorto-coronary bypass candidates, seven valvular and four congenital heart disease). We further performed a prospective blinded comparison of 47 consecutive cases with severe coronary artery disease (CAD) with respect to localization and number of significant coronary lesions, obtained by direct scrutiny of the original angiograms and the evaluation obtained with the teletransmitted images.


RESULTS
In 89 cases of the 98 analyzed (91%) correct diagnosis and surgical approach could be established by distant transmission. In nine cases (9%, all aortocoronary bypass candidates) definitive diagnosis and treatment was feasible only by direct scrutiny of the original angiograms. Five critically ill patients were urgently referred to the surgical care center based on the correct distant diagnosis. The blinded comparison of distant diagnosis and direct scrutiny of angiograms in defining 1-2-3 vessel CAD was good: r=0.87, P<0.01.


CONCLUSIONS
Initial experience using non-sophisticated telemedical transmission of angiograms of cardiac surgery candidates seems to be a promising facility for distantly located centers.
Division of Cardiology, Ospedale San Giovanni, CH-6500 Bellinzona, Switzerland.
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RF
Bonvini
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Caoduro
A
A
Menafoglio
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Calanca
L
L
von Segesser
A
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Gallino
D006348:Cardiac Surgical Procedures; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000601:surgery; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000601:surgery; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D011446:Prospective Studies; D019114:Remote Consultation; D012189:Retrospective Studies; D019112:Teleradiology