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Published on: February 20, 2017
[Echocardiography in diagnosis of pediatric pulmonary artery sling]
Chunze Song1, Guoping Jiang1, Jingjing Ye1
1Department of Ultrasonography, the Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China.
Insights
Echocardiography effectively diagnoses pediatric pulmonary artery sling by analyzing pulmonary artery ratios. Specific ratios of the right pulmonary artery to main pulmonary artery (RPA/MPA) and left pulmonary artery to main pulmonary artery (LPA/MPA) serve as diagnostic indicators.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging
- Congenital Heart Disease
Background:
- Pulmonary artery sling is a rare congenital anomaly where the left pulmonary artery arises from the right pulmonary artery.
- Accurate diagnosis is crucial for timely intervention and management of associated respiratory and cardiovascular complications.
- Conventional diagnostic methods may have limitations in visualizing the precise anatomy of the pulmonary arteries in pediatric patients.
Purpose of the Study:
- To evaluate the diagnostic utility of echocardiography in identifying pediatric pulmonary artery sling.
- To determine specific echocardiographic parameters and their cutoff values for accurate diagnosis.
- To assess the sensitivity and specificity of echocardiography in diagnosing this condition.
Main Methods:
- A retrospective study included 25 children diagnosed with pulmonary artery sling and 50 healthy controls.
- Echocardiography was performed to assess the origins and measure the internal diameters of the left pulmonary artery (LPA), right pulmonary artery (RPA), and main pulmonary artery (MPA).
- Ratios of RPA/MPA and LPA/MPA were calculated, and Receiver Operating Characteristic (ROC) curve analysis was used to evaluate diagnostic performance.
Main Results:
- Echocardiography revealed enlarged RPAs in all pulmonary artery sling patients, with absent LPA origins in 24 cases.
- Significant differences were observed in RPA/MPA (0.50±0.05 vs. 0.71±0.15) and LPA/MPA (0.52±0.05 vs. 0.39±0.09) between patients and controls (P<0.01).
- ROC analysis showed high diagnostic accuracy, with Area Under the Curve (AUC) of 0.90 for RPA/MPA and 0.89 for LPA/MPA. Cutoff values of 0.60 for RPA/MPA and 0.43 for LPA/MPA demonstrated high sensitivity and specificity.
Conclusions:
- Echocardiography is an effective non-invasive tool for diagnosing pediatric pulmonary artery sling.
- The RPA/MPA ratio of 0.60 and LPA/MPA ratio of 0.43 are reliable cutoff values for diagnosis.
- These echocardiographic parameters offer high accuracy, sensitivity, and specificity in identifying this rare anomaly.
Objective:
To evaluate the application of echocardiography in diagnosis of pediatric pulmonary artery sling.
Methods:
Twenty-five children diagnosed as pulmonary artery sling in the Children's Hospital, Zhejiang University School of Medicine from July 2012 to August 2017, and 50 healthy children(control group) were enrolled in the study. Echocardiography was performed in all subjects. The origins of the left pulmonary artery(LPA) and right pulmonary artery(RPA) were observed; the internal diameters of LPA, RPA and main pulmonary artery(MPA) were measured; and the ratios of LPA/MPA and RPA/MPA were calculated. The value of RPA/MPA and LPA/MPA in diagnosing pulmonary artery sling was evaluated by ROC curve.
Results:
Echocardiography showed that the internal diameters of RPA were increased in all patients; while the LPA and blood flow signals in common pulmonary arterial bifurcation were not found in 24 cases, in whom the MPA was directly extended to the RPA, and the LPA was from the massive RPA. The ultrasound of one special case showed that there was no distinct bifurcation of MPA; the MPA walked to the right and then to the left with no change in the internal diameter. There were significant differences in RPA/MPA(0.50±0.05 vs. 0.71±0.15, t=7.06, P<0.01) and LPA/MPA(0.52±0.05 vs. 0.39±0.09, t=6.94, P<0.01) between controls and the patients. ROC curve analysis showed that the AUC of RPA/MPA and LPA/MPA in diagnosis of pulmonary artery sling were 0.90 and 0.89, respectively. When taking 0.60 as the cutoff value, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of RPA/MPA in diagnosis of pulmonary artery sling were 79%, 100%, 100%, 91% and 93%, respectively. When taking 0.43 as the cutoff value, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of LPA/MPA in diagnosis of pulmonary artery sling were 71%, 96%, 89%, 87% and 88%, respectively.
Conclusions:
s Echocardiography can effectively diagnose pediatric pulmonary artery sling. The RPA/MPA ratio of 0.60 and the LPA/MPA ratio of 0.43 can be used as cutoff values for diagnosis.
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