Will a handheld ultrasound scanner be applicable for screening for heart abnormalities in newborns and children?
BACKGROUND
There is significant interest in opportunities to provide echocardiography services for detection of congenital heart disease with portable, or even handheld, devices in remote areas or third world countries where conventional ultrasound systems may not be available. We tested a handheld system (HHS) (SonoHeart, SonoSite Inc, Bothell, Wash) equipped with a broadband, 7- to 4-MHz, miniaturized, curved, linear-array transducer and implemented with an improved directional Doppler flow map.


METHODS
All echocardiography scanning was performed in the neonatal nursery, pediatric intensive care department, or pediatric echocardiography laboratory of our institution. We reviewed limited echocardiography view sequences sequentially obtained by the same expert examiner (D.J.S.) in 50 infants and children (age: 1 day to 6 years), with preoperative or postoperative forms of congenital heart disease. Each patient was studied twice, once with a conventional full-feature system (FFS) and then a limited scan with the HHS using similar frequency transducers. The cardiologist (D.J.S.) and blinded research laboratory reviewers (X.L., G.K.M., R.A.R.) read the FFS and HHS image sequences for diagnosis and for grading the quality of the anatomic and flow feature images. The studies were performed and reviewed with the examiner and reviewers blinded to patient diagnosis.


RESULTS
The major diagnoses (eg, patent ductus arteriosus, atrio-ventricular (AV) canal, peripheral pulmonary valve stenosis, aortic coarctation, atrial septal defect, ventricular septal defect, preoperative or postoperative tetralogy of Fallot, and mitral regurgitation) were made by both readers, who were unaware of each other's diagnosis results. Furthermore, the average composite HHS cardiac anatomic feature score on a scale of 0 (not visualized) to 3 (visualized precisely) from the parasternal long-axis and 4- or 5-chamber view for cardiac anatomy were 2.67 +/- 0.49 (SD) and 2.50 +/- 0.55, respectively, versus 2.73 +/- 0.45 and 2.55 +/- 0.54 for the FFS. The mean flow feature score, comprising all views, was 2.67 +/- 0.45 (HHS) versus 2.72 +/- 0.48 (FFS). The P values for all above comparisons were >.05. Image quality of the FFS anatomic structures were, thus, not statistically different from the HHS. Although the color cosmetic was different for the HHS directional (nonvelocity) map, only 9% of 150 total findings (including structural abnormalities and flow features, none of which were critical) were missed, whereas the other 91% regurgitant, shunt, stenosis flow features or heart structure were imaged adequately by the HHS in this population.


CONCLUSIONS
Implementing high-frequency transducers and programs optimized for tissue and flow imaging on the HHS should provide images of sufficient quality for targeted echocardiography examinations to determine the presence, absence, or status of congenital heart disease in newborns and young children.
Li
Xiaokui
X
Clinical Care Center for Congenital Heart Disease, Oregon Health and Science University, Portland, USA.
Mack
Gordon K
GK
Rusk
Rosemary A
RA
Dai
Xiao-Nan
XN
El-Sedfy
Ghada O M
GO
Davies
Crispin H
CH
Sahn
David J
DJ
D001021:Aortic Valve / Q000002:abnormalities / Q000000981:diagnostic imaging; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D034201:Computers, Handheld; D004452:Echocardiography / Q000295:instrumentation; D018618:Echocardiography, Doppler, Color; D006330:Heart Defects, Congenital / Q000145:classification / Q000175:diagnosis*; D006344:Heart Septal Defects, Atrial / Q000145:classification / Q000175:diagnosis; D006345:Heart Septal Defects, Ventricular / Q000145:classification / Q000175:diagnosis; D006349:Heart Valve Diseases / Q000145:classification / Q000151:congenital / Q000175:diagnosis; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D007223:Infant; D007229:Infant Welfare; D007231:Infant, Newborn; D008403:Mass Screening; D009922:Oregon; D011664:Pulmonary Valve / Q000002:abnormalities / Q000000981:diagnostic imaging; D012720:Severity of Illness Index; D014261:Tricuspid Valve / Q000002:abnormalities / Q000000981:diagnostic imaging