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[Color flow mapping 2-D Doppler in determining surgical indication for congenital heart disease]
1Department of Surgery, Saitama Medical School.
Insights
Real-time two-dimensional Doppler echocardiography can accurately diagnose congenital heart disease (CHD), potentially eliminating the need for cardiac catheterization in many surgical candidates. Further research is needed to establish definitive criteria for omitting this invasive procedure.
Area of Science:
- Cardiology
- Medical Imaging
- Pediatric Medicine
Context:
- Real-time two-dimensional Doppler echocardiography (2-D Doppler) is a recognized diagnostic tool for cardiovascular diseases.
- The role of 2-D Doppler in determining surgical indications for congenital heart disease (CHD) and potentially avoiding preoperative cardiac catheterization requires further investigation.
Purpose:
- To evaluate the diagnostic accuracy of 2-D Doppler in patients with CHD and assess its potential to obviate the need for preoperative cardiac catheterization.
Summary:
- A study of 278 CHD patients found 2-D Doppler diagnosis to be highly accurate (89.8% in Group A, 100% in Group B).
- Surgical procedures were performed as planned in 92.7% of cases based on 2-D Doppler findings.
- The study suggests that preoperative cardiac catheterization could be omitted in up to 90% of surgical candidates with CHD, provided established criteria and exclusion of coronary abnormalities.
Impact:
- This research indicates a significant potential to reduce invasive procedures for CHD patients.
- Establishing clear 2-D Doppler criteria for surgical indications could streamline CHD management and improve patient outcomes.
Abstract:
Real-time two-dimensional Doppler echocardiography (2-D Doppler) is established as an effective diagnostic tool for cardiovascular diseases. However, in determining indications for surgery of congenital heart disease (CHD), the possibility of avoiding preoperative cardiac catheterization including radiographic angiography, has not been fully discussed since the clinical introduction of 2-D Doppler. We evaluated 278 patients with CHD by 2-D Doppler including ASDs (75 patients), VSD (76 patients), TOF (23 patients), TGA (12 patients), PDA (23 patients), ECD (13 patients), and 60 miscellaneous types of CHD during 27 months. The diagnosis of the 278 patients were confirmed by catheterization and/or surgery. Of these, 114 patients underwent corrective surgery (83 patients) or palliative procedures (31 patients). Preoperative cardiac catheterization was performed for 88 patients (Group A), and omitted in 26 patients (Group B). The 2-D Doppler diagnosis was correct in 79 patients of Group A (89.8%) and in 26 patients of Group B (100%). The surgical procedures scheduled according to the preoperative 2-D Doppler diagnosis were performed for these 105 patients (92.7%) without any corrections by cardiac catheterization diagnosis or by surgical findings. However, 2-D Doppler failed to establish the preoperative diagnosis for six patients in Group A (two patients with ASD, three with PDA, and one with TOF) and failed to detect associated cardiac abnormalities for three patients in Group A (two with PAPVC, one with Azygos connection). Results of this study suggest that preoperative cardiac catheterization could be omitted in a maximum of about 90% of surgical candidates with CHD. However, to omit cardiac catheterization 2-D Doppler echocardiographic criteria for indications for surgery in each group of CHD must be established, and any associated coronary artery abnormalities must be ruled out.