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Sonography of extrathoracic left-to-right shunts in infants and children
Insights
High-resolution sonography effectively identified congenital heart defects in infants, including arteriovenous malformations causing heart failure. This imaging technique aids in early diagnosis and guides further diagnostic procedures for complex cardiac conditions.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging
- Congenital Heart Disease
Background:
- Congenital heart defects, particularly left-to-right shunts, can manifest with severe symptoms like congestive heart failure in infants.
- Accurate and timely diagnosis is crucial for effective management of these complex conditions.
Observation:
- This study presents experience with four infants diagnosed with extrathoracic left-to-right shunts.
- Arteriovenous malformations (AVMs) in intracranial and parahepatic locations were identified as a cause of congestive heart failure.
- Partial anomalous pulmonary venous return was observed in two patients, associated with other congenital cardiac anomalies.
Findings:
- High-resolution, real-time sonography proved valuable in the initial evaluation of these infants.
- Sonography successfully localized arteriovenous malformations.
- The imaging modality directed subsequent diagnostic strategies towards the most informative and least invasive studies.
Implications:
- Real-time sonography serves as an effective initial imaging tool for suspected arteriovenous malformations in infants.
- Early localization of vascular anomalies via sonography can streamline diagnostic pathways.
- This approach aids in the prompt management of congenital heart disease presenting with heart failure.
Abstract:
Experience with high-resolution, real-time sonography of four infants with differing extrathoracic left-to-right shunts is presented. Intracranial and parahepatic arteriovenous malformations gave rise to congestive heart failure as their primary or sole manifestation. Partial anomalous pulmonary venous return to the inferior vena cava in one patient and to the portal vein in another was associated with other congenital cardiac anomalies. Once an arteriovenous malformation was suspected, sonography was useful as the initial imaging procedure to localize it and to direct attention to the most useful and least hazardous studies for detailed evaluation.