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A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Screening and diagnostic imaging at centres performing congenital heart surgery in middle-income countries
Amara Majeed1,2, Kathy Jenkins1,2, Kimberlee Gauvreau1,2
1Departments of Cardiology, Harvard Medical School, Boston, MA, USA.
Insights
Cardiac imaging infrastructure is growing in low- and middle-income countries, but advanced tools and prenatal screening for congenital heart disease (CHD) remain limited. Further study is needed to understand imaging
Area of Science:
- Cardiology
- Medical Imaging
- Global Health
Background:
- Surgical care for congenital heart disease (CHD) is expanding in low- and middle-income countries (LMICs).
- Optimizing surgical outcomes requires understanding existing cardiac imaging and prenatal diagnostic capabilities in these regions.
Purpose of the Study:
- To characterize the availability of cardiac imaging modalities and prenatal diagnostic infrastructure for CHD in LMICs.
- To assess the association between imaging infrastructure and surgical outcomes (in-hospital and 30-day mortality).
Main Methods:
- An infrastructure survey was distributed to sites in the International Quality Improvement Collaborative for CHD.
- The survey included questions on echocardiography (transthoracic, transesophageal, epicardial), cardiac CT, cardiac MRI, and prenatal screening/fetal echocardiography.
- Data on in-hospital and 30-day mortality were collected and analyzed.
Main Results:
- Thirty-seven sites across 17 countries participated, showing significant variation in program size and geography.
- Transthoracic echocardiography is widely available; transesophageal and epicardial echocardiography are common (86-89%).
- Cardiac CT is available in most sites (81%), but cardiac MRI is less common (54%).
- One-third of sites reported imaging impediments (e.g., lack of portable machines, training).
- Prenatal CHD screening is low (19% universal), and fetal echocardiography use is limited (46% when indicated).
- No significant association was found between imaging modality availability and surgical outcomes.
Conclusions:
- Echocardiography is accessible in most LMICs, but advanced imaging like CT and MRI are not consistently available.
- Prenatal screening for CHD and fetal echocardiography availability are limited in these settings.
- Further research is warranted to investigate imaging infrastructure in LMICs and its impact on patient outcomes.
Background:
Surgical care for CHD is increasingly available in low- and middle-income countries, and efforts to optimise outcomes are growing. This study characterises cardiac imaging and prenatal diagnosis infrastructure in this setting.
Methods:
An infrastructure survey was administered to sites participating in the International Quality Improvement Collaborative for CHD. Questions regarding transthoracic, transesophageal and epicardial echocardiography, cardiac CT, cardiac magnetic resonance, prenatal screening and fetal echocardiography were included. Associations with in-hospital and 30-day mortality were assessed.
Results:
Thirty-seven sites in 17 countries responded. Programme size and geography varied considerably: < 250 cases (n = 13), 250-500 cases (n = 9), > 500 cases (n = 15); Americas (n = 13), Asia (n = 18), and Eastern Europe (n = 6). All had access to transthoracic echo. Most reported transesophageal and epicardial echocardiography availability (86 and 89%, respectively). Most (81%) had cardiac CT, but only 54% had cardiac magnetic resonance. A third reported impediments to imaging, including lack of portable machines, age/size-appropriate equipment and advanced cardiac imaging access and training. Only 19% of centres reported universal prenatal CHD screening in their catchment area, and only 46% always performed fetal echocardiography if screening raised concern for CHD. No statistically significant associations were identified between imaging modality availability and surgical outcomes.
Conclusions:
Although access to echocardiography is available in most middle-income countries; advanced imaging modalities (cardiac CT and magnetic resonance) are not always accessible. Prenatal screening for CHD is low, and availability of fetal echocardiography is limited. Imaging infrastructure in low- and middle-income countries and associations with outcomes merits additional study.
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