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Paediatric follow-up of haemodynamically insignificant congenital cardiac lesions

Benjamin G Smith1, Shakeel A Qureshi

  • 1Department of Paediatric Cardiology, Royal Hospital for Sick Children, Glasgow, United Kingdom.

Journal of Paediatrics and Child Health
|May 25, 2012
PubMed

Insights

Follow-up for hemodynamically insignificant congenital cardiac lesions (HICCL) in the UK varies widely. A rationalized approach suggests limited follow-up after age two, with only two assessments recommended for most HICCL cases.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Disease
  • Echocardiography

Background:

  • Hemodynamically insignificant congenital cardiac lesions (HICCL) represent a spectrum of heart conditions in children.
  • Current follow-up practices for HICCL in the UK are not standardized.
  • Advanced echocardiography may lead to over-investigation and prolonged follow-up.

Purpose of the Study:

  • To describe current follow-up practices for HICCL in the UK.
  • To propose a rationalized follow-up strategy based on the natural history of these lesions.

Main Methods:

  • An internet-based survey was conducted among 170 UK pediatric cardiologists and general pediatricians.
  • Respondents were presented with five common HICCL scenarios: VSD, ASD, PFO, mild PS, and PDA.
  • 52 responses were analyzed to identify trends in follow-up beliefs and practices.

Main Results:

  • Significant variation in follow-up practices for HICCL was observed among respondents.
  • A tendency to discharge patients with patent foramen ovale (PFO) was noted.
  • Most other HICCL lesions were followed, often with frequent reviews.

Conclusions:

  • Over-reliance on advanced echocardiography may result in unnecessary frequent reviews of HICCL.
  • A rationalized follow-up protocol is proposed, recommending no more than two assessments after age two for most HICCL.
  • These recommended assessments should occur in late childhood and near full growth.
Abstract

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