Ventricular septal defect in infancy: detection with two dimensional echocardiography

Area of Science:

• Pediatric Cardiology
• Diagnostic Imaging
• Congenital Heart Disease

Background:

• Ventricular septal defects (VSDs) are common congenital heart abnormalities.
• Accurate and early diagnosis is crucial for appropriate management in infants.
• Two-dimensional echocardiography is a non-invasive imaging modality used for cardiac assessment.

Purpose of the Study:

• To evaluate the diagnostic accuracy of two-dimensional echocardiography (2DE) for ventricular septal defects (VSDs) in infants.
• To determine the sensitivity and specificity of 2DE in detecting VSDs compared to cardiac catheterization.

Main Methods:

• Fifty-three infants under one year of age underwent 2DE using a 3.5 MHz transducer.
• Imaging included long axis and four-chamber views (apical/subcostal).
• Diagnosis confirmation was by cardiac catheterization or clinical assessment.

Main Results:

• 2DE correctly identified 74% (20/27) of VSDs; 7 defects were missed, all smaller than 4 mm.
• No defects smaller than 4 mm were detected.
• 2DE correctly excluded a defect in 88% (23/26) of infants with an intact septum; 3 false positives occurred.

Conclusions:

• Two-dimensional echocardiography detects approximately three-fourths of VSDs significant enough for cardiac catheterization in the first year of life.
• Smaller VSDs (<4 mm) and those in the membranous septum may be missed due to echo dropout.
• While valuable, 2DE has limitations in VSD detection, especially for subtle or small defects.