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When is echocardiography unreliable in patients undergoing catheterization for pediatric cardiovascular disease?
T Kandah1, T R Kimball, S R Daniels
1Division of Pediatric Cardiology, Children's Hospital Medical Center, University of Cincinnati, College of Medicine, OH 45229.
Insights
Echocardiography is often insufficient for definitive diagnosis in pediatric cardiac patients, with discrepancies noted in 155 cases. Clinically significant discrepancies occurred in 35% of cases, impacting patient management.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging
- Medical Technology
Background:
- Technological advancements in echocardiography have improved diagnostic capabilities.
- However, diagnostic catheterization remains essential in certain pediatric cardiac conditions.
Purpose of the Study:
- To assess the sufficiency of echocardiography in delineating cardiac anatomy and flow abnormalities in pediatric patients.
- To identify circumstances where echocardiography fails to establish a definitive diagnosis.
Main Methods:
- Retrospective analysis of 252 pediatric echocardiograms compared with subsequent catheterization data.
- Evaluation of discrepancies for clinical significance by independent cardiologists.
Main Results:
- Echocardiographic assessments were discrepant with catheterization findings in 155 instances (61.5%).
- Clinically significant discrepancies, impacting patient management, were identified in 54 cases (35% of discrepancies).
- Commonly discrepant findings included extracardiac lesions (43%), pressure gradients (37%), and intracardiac lesions (13%).
Conclusions:
- Echocardiography alone is not always sufficient for definitive diagnosis in pediatric cardiac patients.
- Discrepancies often involve extracardiac anomalies and pressure gradients, necessitating catheterization for accurate assessment and management decisions.
Abstract:
Technologic advances in echocardiography (e.g., better spatial resolution, Doppler, and color flow mapping) have improved our ability to demonstrate anatomy and physiology in previously problematic conditions, precluding catheterization and angiography in some instances. However, diagnostic catheterization remains necessary in other instances. The aims of this study were to determine whether echocardiography alone was sufficient to delineate the anatomic and flow abnormalities in patients subsequently selected to undergo catheterization and, if not, under what circumstances was echocardiography unable to establish the definitive diagnosis. Echocardiograms of 252 infants and children who underwent catheterization during a 14-month interval were analyzed retrospectively to determine whether the echographic assessment was nondiscrepant (group 1) or discrepant (group 2) with the catheterization assessment. Any deviation in the complete accurate assessment constituted a discrepancy; identification of more than one discrepancy in a single patient was possible. Independent variables included patient's age, weight, operative status, use of color flow mapping, echocardiograph operator, and interval between echocardiogram and catheterization. To determine whether the discrepancies were clinically significant, data from patients in group 2 were reviewed independently by three cardiologists to determine whether patient management would have changed given the added data provided by catheterization. Echocardiographic evaluations were discrepant in 155 instances. In 54 of 155 instances (35%), discrepancies were judged to be clinically significant (group 3). Twenty-three of 54 cases (43%) involved extracardiac lesions (i.e., aortic arch, pulmonary arterial, bronchial collateral, and pulmonary venous anomalies), 20 of 54 (37%) involved pressure gradients, 7 of 54 (13%) involved intracardiac lesions, and 4 of 54 (7%) involved coronary arterial lesions.(ABSTRACT TRUNCATED AT 250 WORDS)