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Surgery without catheterization for congenital heart defects: management of 100 patients
Insights
Omitting cardiac catheterization in children with congenital heart disease (CHD) and relying on echocardiography showed comparable surgical mortality. This approach may offer a trend toward improved survival in selected pediatric CHD patients.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Background:
- Congenital heart disease (CHD) diagnosis often involves invasive cardiac catheterization.
- The impact of omitting preoperative catheterization on surgical mortality in pediatric CHD is not well-established.
Purpose of the Study:
- To compare the early surgical mortality of pediatric CHD patients managed with echocardiography alone versus those undergoing cardiac catheterization.
- To determine if echocardiography is a reliable and safe alternative to catheterization for preoperative diagnosis in pediatric CHD.
Main Methods:
- Retrospective comparison of 100 pediatric CHD patients managed with echocardiography (Group I) versus 151 diagnosis-matched controls who had cardiac catheterization (Group II).
- Data collected included patient demographics, diagnosis, age, preoperative condition, and surgical mortality.
- Logistic regression analysis was used to adjust for differences in age and preoperative condition.
Main Results:
- Echocardiographic diagnoses were accurate in most cases compared to surgical or autopsy findings.
- Initial surgical mortality was 18% in the echocardiography group (Group I) and 9% in the catheterization group (Group II).
- After adjusting for confounding factors, no significant difference in mortality was observed, with a trend towards lower mortality in Group I (p=0.075).
Conclusions:
- Echocardiography is an accurate diagnostic modality for selected pediatric congenital heart disease patients.
- Managing pediatric CHD patients with echocardiography without preoperative catheterization demonstrates comparable surgical outcomes to conventional methods.
Abstract:
Little information is available regarding the surgical mortality of children with congenital heart disease who undergo operation on the basis of clinical assessment and echocardiographic diagnosis without cardiac catheterization. If catheterization affects early surgical mortality then perhaps omitting it would improve survival. Early operative mortality of 100 patients managed with echocardiography without preoperative catheterization (Group I) was compared with that of 151 diagnosis-matched control patients who had catheterization (Group II). The catheterization (Group II) and echocardiographic (Group I) groups included patients with the following diagnoses: atrial septal defect (33 and 17 in Group II and Group I, respectively); pulmonary stenosis/pulmonary atresia (33 and 15), aortic stenosis (14 and 3), coarctation of aorta (36 and 29), patent ductus arteriosus (10 and 15) and miscellaneous (25 and 21). Age range was 1 day to 16 years (mean 3.5); 114 (45%) of the 251 patients were less than 1 year of age and 59 (29%) were less than 1 month of age. With one exception, echocardiographic diagnosis was correct when compared with findings at surgery or autopsy, or both. Surgical mortality was 18% in Group I and 9% in Group II; however, multiple logistic regression analysis adjusting for differences in age and preoperative condition showed no significant difference between the two groups with a trend toward lower mortality in Group I (p = 0.075). Echocardiography as the definitive imaging modality in selected patients with congenital heart disease is accurate and is comparable with conventional methods of preoperative diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)