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[Limitations of two-dimensional echocardiography in infants under one month of age]
F Aka1, A Chantepie, M C Vaillant
1Service de Pédiatrie A, Hôpital Clocheville, Tours.
Insights
Two-dimensional echocardiography (TD echo) effectively detects congenital heart disease in neonates, with high sensitivity and specificity. This imaging technique can guide surgical decisions, potentially reducing the need for invasive diagnostic procedures.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging
- Congenital Heart Disease
Background:
- Congenital heart disease (CHD) is a significant concern in neonates.
- Accurate and timely diagnosis is crucial for effective management.
- Two-dimensional echocardiography (TD echo) is a primary non-invasive imaging modality.
Purpose of the Study:
- To evaluate the diagnostic accuracy of TD echo for CHD in infants.
- To assess the sensitivity and specificity of TD echo in identifying cardiovascular abnormalities.
- To determine the impact of TD echo on subsequent diagnostic and therapeutic strategies.
Main Methods:
- Investigated 133 neonates with CHD using TD echo.
- Correlated TD echo findings with hemodynamic, angiographic, post-mortem, and operative data.
- Calculated sensitivity, specificity, and diagnostic accuracy rates for TD echo.
Main Results:
- TD echo identified 201 of 234 cardiovascular abnormalities (86% sensitivity, 94% specificity).
- Correct diagnosis was achieved in 75% of cases; incomplete or imprecise diagnoses occurred in 21.6%.
- Anomalous venous drainage, persistent ductus arteriosus, and pulmonary stenosis were frequently missed or difficult to characterize.
Conclusions:
- TD echo is a valuable tool for diagnosing neonatal CHD, enabling non-invasive management in many cases.
- It can reduce the need for invasive endocavitary investigations and preoperative catheterization for closed-heart surgeries.
- Complex defects requiring open-heart surgery still necessitate comprehensive clinical, angiographic, and hemodynamic evaluations.
Abstract:
One hundred and thirty-three children less than one month of age and presenting with congenital heart disease were investigated using two-dimensional echocardiography (TD echo). In these children, 234 cardiovascular abnormalities had been proven by hemodynamic and angiographic investigations (n = 103), post-mortem examinations (n = 15) or operative findings (n = 12). TD echo identified 201 cardiovascular abnormalities with 33 false negatives (sensitivity 86%) and 12 false positives (specificity 94%). Diagnosis after TD echo was correct in 100 children (75%), incomplete in 18 (13.5%), imprecise in 11 (8.3%) and false in 4 (3%). The most frequently unrecognized lesions were: anomalous systemic venous drainage (5/8), persistent ductus arteriosus (5/12), pulmonary stenosis (3/8), ventricular septal defect (5/27), coarctation (2/18). The lesions difficult to characterize concerned mostly the pulmonary valve and the aspect of the aortic arch. On the other hand, TD echo allowed to correctly identify major intracardiac abnormalities, malpositions of the great vessels and to well appreciate the dimensions of the trunk and branches of the pulmonary artery. These results allow to refrain from diagnostic endocavitary investigations in most of the heart defects revealed in the neonatal period and to perform curative or palliative closed heart surgery without preoperative catheterization. However, clinical, angiographic and hemodynamic investigations keep an important place in the preoperative evaluation of defects that may benefit from open heart surgery.