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Ventricular septal defect in infancy: detection with two dimensional echocardiography
Insights
Two-dimensional echocardiography detected 74% of ventricular septal defects in infants, missing smaller defects. This imaging technique is valuable but has limitations in diagnosing these heart conditions.
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.
Abstract:
To determine the sensitivity and specificity of two dimensional echocardiography in detecting ventricular septal defect two dimensional echocardiograms were performed on 53 infants under 1 year of age. The diagnosis of ventricular septal defect was confirmed by cardiac catheterization in 27 patients; an intact ventricular septum was confirmed by catheterization in 18 and clinically in 8. Using a 35 degree mechanical sector scanner with a 3.5 megahertz transducer, we imaged the ventricular septum in the long axis and in a four chamber view (apical or subcostal, or both). Images were recorded on videotape and reviewed independently by two observers unaware of the diagnosis. Interobserver agreement was 94 percent. Among the 27 patients with a ventricular septal defect, the lesion was correctly identified in 20 (74 percent) and was undetected in 7 (3 of whom had a defect less than 4 mm in diameter, as determined by angiography). No defect less than 4 mm in diameter was detected. Among the 26 patients with an intact septum, a defect was correctly excluded in 23 (88 percent); a false positive diagnosis was made in 3. The apical and subcostal views demonstrated the greatest number of defects (20 of 20), but also gave the highest number of false positive diagnoses (3 of 3). The long axis view was helpful when positive, but showed only 9 of 20 of the defects. In this study, two dimensional echocardiography detected approximately three fourths of ventricular septal defects large enough to warrant cardiac catheterization in the 1st year of life. False positive diagnoses were related to dropout of echoes in the membranous septum when imaged in the four chamber views.