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[Echocardiographic findings in children with "innocent" murmur]
Cora Firpo1, Lúcia Pellanda, Gladis H C Gomes
1Trabalho realizado no setor de Cardiologia Pediátrica do Instituto de Cardiologia do Rio Grande do Sul/ Fundação Universitária de Cardiologia, Porto Alegre, RS. pesquisa@cardiologia.org.br
Insights
In a pediatric cardiology clinic, 6.6% of patients diagnosed with innocent murmurs had abnormal echocardiograms, revealing minor heart lesions. This finding questions the routine use of echocardiograms for innocent murmurs due to low detection rates of significant issues.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging
Background:
- Innocent murmurs are common in children and typically benign.
- Echocardiography is often used to rule out underlying cardiac pathology.
Purpose of the Study:
- To determine the frequency of abnormal echocardiographic findings in pediatric patients diagnosed with innocent murmurs.
- To evaluate the clinical significance of these findings in a referral setting.
Main Methods:
- A transversal study included 166 consecutive pediatric patients with an innocent murmur diagnosis.
- All patients underwent clinical examination and echocardiography.
- Post-test probabilities were calculated using echocardiogram as the gold standard.
Main Results:
- 11 out of 166 patients (6.6%) had abnormal echocardiograms.
- Detected abnormalities included pulmonary stenosis, patent foramen ovale, atrial septal defect, bicuspid aortic valve, and ventricular septal defect.
- The negative post-test probability of significant disease was low.
Conclusions:
- A notable proportion of patients with innocent murmurs show minor echocardiographic abnormalities.
- Some detected lesions, like patent foramen ovale and bicuspid aortic valve, may be incidental and unrelated to the murmur.
- The study questions the routine indication of echocardiograms for innocent murmurs due to low yield and low risk of detected lesions.
Objectives:
To access the frequency of abnormal echocardiographic findings in patients with diagnosis of innocent murmur.
Methods:
A transversal study of 166 consecutive patients was carried out with diagnosis of innocent murmur evaluated in the pediatric cardiology outpatient clinic of "Instituto de Cardiologia/Fundação Universitária de Cardiologia", a tertiary reference center, between December 3, 2001 and December 2, 2002. History, clinical examination and echocardiogram were performed in all patients. Post-test probabilities of disease with positive and negative clinical examination were estimated, considering the echocardiogram as gold standard.
Results:
Of the 166 patients evaluated, 11 showed some alteration in the echocardiogram: pulmonary stenosis (4), patent foramen ovale (2), atrial septal defect (1), bicuspid aortic valve (2), minimum aortic regurgitation (1) and ventricular septal defect (1). Negative post-test probability (probability of disease with diagnosis of innocent murmur) was of 6.6%.
Conclusion:
In a referral outpatient clinic the proportion of minor lesions is high in patients with diagnosis of innocent murmur. These injuries may not be related to the heart murmur, as in the patent foramen ovale and bicuspid aortic valve. However, they raise the question of the indication of echocardiogram taking into account the low risk of detected lesions and, on the other hand, the resolutive character of a daycare reference center.
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