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Contrast two-dimensional echocardiography in congenital heart disease: techniques, indications and clinical utility
1Department of Pediatrics, University of California, San Francisco School of Medicine.
Insights
Saline contrast echocardiography effectively diagnoses congenital heart disease in children. This method identifies patent foramen ovale, septal defects, and post-surgical complications, aiding in accurate diagnosis and treatment planning.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging
- Echocardiography
Background:
- Congenital heart disease (CHD) diagnosis requires precise imaging techniques.
- Echocardiography is a key tool, but contrast enhancement can improve visualization.
Purpose of the Study:
- To evaluate the utility of saline contrast echocardiography in diagnosing various congenital heart conditions in children.
- To assess its role in both initial diagnosis and postoperative assessment.
Main Methods:
- Saline contrast echocardiography performed on 889 pediatric patients (June 1976-Feb 1988).
- Analysis of findings including right-to-left shunting, septal defects, coronary artery fistulas, and pulmonary arteriovenous malformations.
- Evaluation of postoperative patients for residual defects and complications.
Main Results:
- Identified right-to-left shunting through patent foramen ovale in 37% of structurally normal hearts, more common in infants.
- Differentiated atrial septal defect types and identified difficult muscular ventricular septal defects.
- Diagnosed coronary artery fistulas, pulmonary arteriovenous malformations, and situs abnormalities.
- Assessed postoperative status, detecting patch leaks and residual defects after various surgical repairs.
Conclusions:
- Saline contrast echocardiography is a versatile diagnostic tool for a broad range of pediatric congenital heart diseases.
- It is valuable for identifying intracardiac shunts, complex lesions, and evaluating surgical outcomes.
Abstract:
Saline contrast echocardiography was performed in 889 children from June 1976 through February 1988. One-third of these studies were in postoperative patients. A patent foramen ovale was identified by finding right to left shunting on venous contrast injection in 37% of 127 children studied with a structurally normal heart. The incidence of such shunting was greater at younger ages (55% younger than 1 month versus 22% older than 1 month). In most patients with an atrial or ventricular septal defect, some right to left shunting was demonstrable. The technique was useful in distinguishing different forms of atrial septal defect and identifying muscular ventricular septal defects that were difficult to image directly. The technique was used in the catheterization laboratory to aid in the identification of congenital coronary artery fistulas and was diagnostic in two cases of pulmonary arteriovenous malformation. In patients with situs abnormalities, the technique was useful in identifying the systemic venous connections to the atria. Contrast echocardiography was also used in postoperative evaluations. The technique was useful in identifying patch leaks and residual defects after Senning, Mustard and Fontan operations, and after closure of atrial and ventricular septal defects. Most patients were found to have no superior vena cava obstruction by contrast echocardiography after the Senning or Mustard procedure. Contrast echocardiography continues to be a useful technique in the diagnosis of a wide spectrum of congenital heart disease, as well as in the postoperative evaluation of congenital heart surgery.