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Njem JM, Edwin F, Tettey M. Comparison of preoperative trans-thoracic echocardiography with intraoperative findings in patients with congenital heart disease undergoing surgery: a prospective observational study. J Cardiothorac Surg 2021; 16:332. [PMID: 34774084 PMCID: PMC8590322 DOI: 10.1186/s13019-021-01711-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 11/01/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To determine the diagnostic accuracy and safety of trans-thoracic echocardiography alone for indicating surgery by correlating preoperative trans-thoracic echocardiography with intra-operative findings in patients with congenital heart disease (CHD) in a low resource, low volume center. METHODOLOGY The pre-operative trans-thoracic echocardiography and intra-operative findings of two hundred and fifty patients with CHD, undergoing surgery at the National Cardiothoracic Centre (NCTC), Korle Bu Teaching Hospital, from 2012 to 2017 were prospectively compared. Included in this prospective study, were all patients with CHD who had trans-thoracic echocardiography alone at the NCTC. Excluded were patients who were operated at the NCTC based on echocardiography done elsewhere, those who had echocardiography at the NCTC but were operated elsewhere, as well as those whose operative decision were based on cardiac catheterization or CT angiography and patients with acquired heart defects. The analysis included profiling of patients on different demographic and clinical parameters. SPSS software was used for analysis. RESULTS Of the 250 patients ages ranged from 2 months to 60 years. The mean was 4 years 95 days, median 1 year 180 days. The female sex accounted for 152 (60.6%). The preoperative trans-thoracic echocardiography correlated with intra-operative findings completely in 228 (91.2%) of patients, affirming the accuracy of this imaging modality. There were however, 19 (7.6%) false negatives and 3 (1.2%) false positive. Neither the false positive nor false negative errors resulted in complications or adversely affected the surgical outcome. CONCLUSION Based on the results of this study, preoperative transthoracic echocardiography done by cardiologists at the National Cardiothoracic Center, Korle Bu Teaching Hospital Accra, demonstrated a high correlation with intraoperative findings. Echocardiography also proved to be sensitive, accurate and safe for indicating surgery in patients with congenital heart disease.
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Affiliation(s)
- Josiah Miner Njem
- National Cardiothoracic Centre, Accra, Ghana.
- Department of Surgery, Jos University Teaching Hospital, PMB 2076, Jos, Plateau State, Nigeria.
| | - Frank Edwin
- National Cardiothoracic Centre, Accra, Ghana
| | - Mark Tettey
- National Cardiothoracic Centre, Accra, Ghana
- University of Ghana School of Medicine and Dentistry, Accra, Ghana
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2
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Fundora MP, Aregullin EO, Wernovsky G, Welch EM, Muniz JC, Sasaki N, Hannan RL, Burke RP, Lopez L. Echocardiographic and Surgical Correlation of Coronary Artery Patterns in Transposition of the Great Arteries. CONGENIT HEART DIS 2016; 11:570-577. [PMID: 26931510 DOI: 10.1111/chd.12338] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Determine the accuracy of echocardiography to diagnose coronary anatomy in transposition of the great arteries and to evaluate the effect of accuracy on surgical outcomes and changes in accuracy over time. DESIGN Retrospective chart review of neonates admitted February 1999 to March 2013 with transposition. Coronary pattern from the preoperative echocardiogram and operative reports were collected and compared with determine diagnostic accuracy. Coronary patterns were further confirmed by intraoperative images taken during surgery. SETTING Tertiary care children's hospital. PATIENTS Neonates with transposition of the great arteries and planned arterial switch operation with an echo and operative report or image describing the coronaries. INTERVENTIONS Not applicable. OUTCOME MEASURES Accuracy of echocardiography to diagnose coronary anatomy in transposition, and to identify factors related to correct diagnosis. RESULTS One hundred forty-two patients met inclusion criteria with 122 correctly diagnosed, 16 incorrect, and 4 inconclusive. Accuracy was 86%, with 95% accuracy in patients with typical coronary patterns, 85% with the most common variant (left coronary from the leftward sinus and right and circumflex from the rightward sinus), and 61% with less common patterns. Typical and common variants were more likely to be correct than atypical patterns (P < .001). Cases with ventricular septal defect were more likely to have correctly diagnosed coronaries than with an intact ventricular septum (94% vs. 79%, P = .01). There was no change in accuracy over time (P > .05). There was no difference in duration of cardiopulmonary bypass, cross-clamp times, length of stay, or postoperative stay between the correct and incorrectly diagnosed groups (P > .05). CONCLUSIONS In our center, accuracy of echocardiographic imaging of the coronary arteries in transposition was 86% without improvement over time, and perioperative outcomes were not affected by diagnostic accuracy. Further invasive imaging may not be necessary to determine the coronary pattern in this lesion.
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Affiliation(s)
- Michael P Fundora
- Department of Pediatric Cardiology, Nicklaus Children's Hospital, Miami Children's Health System, Florida International University, Herbert Wertheim College of Medicine, Miami, Fla, USA
| | - Enrique Oliver Aregullin
- Department of Pediatric Cardiology, Nicklaus Children's Hospital, Miami Children's Health System, Florida International University, Herbert Wertheim College of Medicine, Miami, Fla, USA
| | - Gil Wernovsky
- Department of Pediatric Cardiology, Nicklaus Children's Hospital, Miami Children's Health System, Florida International University, Herbert Wertheim College of Medicine, Miami, Fla, USA
| | - Elizabeth M Welch
- Department of Pediatric Cardiology, Nicklaus Children's Hospital, Miami Children's Health System, Florida International University, Herbert Wertheim College of Medicine, Miami, Fla, USA
| | - Juan-Carlos Muniz
- Department of Pediatric Cardiology, Nicklaus Children's Hospital, Miami Children's Health System, Florida International University, Herbert Wertheim College of Medicine, Miami, Fla, USA
| | - Nao Sasaki
- Department of Pediatric Cardiology, Nicklaus Children's Hospital, Miami Children's Health System, Florida International University, Herbert Wertheim College of Medicine, Miami, Fla, USA
| | - Robert L Hannan
- Department of Cardiovascular Surgery, Nicklaus Children's Hospital, Miami Children's Health System, Florida International University, Herbert Wertheim College of Medicine, Miami, Fla, USA
| | - Redmond P Burke
- Department of Cardiovascular Surgery, Nicklaus Children's Hospital, Miami Children's Health System, Florida International University, Herbert Wertheim College of Medicine, Miami, Fla, USA
| | - Leo Lopez
- Department of Pediatric Cardiology, Nicklaus Children's Hospital, Miami Children's Health System, Florida International University, Herbert Wertheim College of Medicine, Miami, Fla, USA
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3
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Farooqi KM, Uppu SC, Nguyen K, Srivastava S, Ko HH, Choueiter N, Wollstein A, Parness IA, Narula J, Sanz J, Nielsen JC. Application of Virtual Three-Dimensional Models for Simultaneous Visualization of Intracardiac Anatomic Relationships in Double Outlet Right Ventricle. Pediatr Cardiol 2016; 37:90-8. [PMID: 26254102 DOI: 10.1007/s00246-015-1244-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
Abstract
Our goal was to construct three-dimensional (3D) virtual models to allow simultaneous visualization of the ventricles, ventricular septal defect (VSD) and great arteries in patients with complex intracardiac anatomy to aid in surgical planning. We also sought to correlate measurements from the source cardiac magnetic resonance (CMR) image dataset and the 3D model. Complicated ventriculo-arterial relationships in patients with complex conotruncal malformations make preoperative assessment of possible repair pathways difficult. Patients were chosen with double outlet right ventricle for the complexity of intracardiac anatomy and potential for better delineation of anatomic spatial relationships. Virtual 3D models were generated from CMR 3D datasets. Measurements were made on the source CMR as well as the 3D model for the following structures: aortic diameter in orthogonal planes, VSD diameter in orthogonal planes and long axis of right ventricle. A total of six patients were identified for inclusion. The path from the ventricles to each respective outflow tract and the location of the VSD with respect to each great vessel was visualized clearly in all patients. Measurements on the virtual model showed excellent correlation with the source CMR when all measurements were included by Pearson coefficient, r = 0.99 as well as for each individual structure. Construction of virtual 3D models in patients with complex conotruncal defects from 3D CMR datasets allows for simultaneous visualization of anatomic relationships relevant for surgical repair. The availability of these models may allow for a more informed preoperative evaluation in these patients.
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Affiliation(s)
- Kanwal M Farooqi
- Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, NY, USA. .,Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY, USA.
| | - Santosh C Uppu
- Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, NY, USA
| | - Khanh Nguyen
- Department of Pediatric Cardiac Surgery, Mount Sinai Medical Center, New York, NY, USA
| | - Shubhika Srivastava
- Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, NY, USA
| | - H Helen Ko
- Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, NY, USA
| | - Nadine Choueiter
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Adi Wollstein
- Department of Pediatric Cardiac Surgery, Mount Sinai Medical Center, New York, NY, USA
| | - Ira A Parness
- Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, NY, USA
| | - Jagat Narula
- Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY, USA
| | - Javier Sanz
- Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY, USA
| | - James C Nielsen
- Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, NY, USA.,Division of Pediatric Cardiology, Stony Brook University Medical Center, Stonybrook, NY, USA
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4
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Abstract
Echocardiography has revolutionized the management of pediatric and adult heart disease, especially in the diagnosis of congenital heart defects. Although the early methods of echocardiography (M-mode and Doppler imaging) were limited in their ability to define the defect in question, the advent of 2D, and now 3D, imaging have clearly equaled or surpassed traditional methods of diagnosis (e.g., noninvasively obtained plain chest radiographs and electrocardiograms) and invasive tests (e.g., cardiac catheterization and angiography). Confidence in the images obtained using echocardiography has continued to increase, with many patients referred for corrective or palliative surgery on the basis of echocardiographic imaging alone. Echocardiography has eliminated the need, decreased the frequency, or improved the timing or performance of invasive studies in other patients. Specifically, it is used to definitively diagnose a cardiac defect and any associated lesions. It will also provide quantitative information for the assessment of the hemodynamic severity of the lesion. This review outlines the manner in which echocardiography is used to plan and guide congenital heart surgery or intervention, along with some of the advantages and disadvantages (pitfalls) of which to be aware. The use of echocardiography within the cardiac catheterization or surgical theater, as well as in the intensive care unit, is discussed, as is the use of echocardiography as a means of monitoring recovery and follow-up following cardiac surgery. Finally, the authors discuss who is best qualified or suited to perform these tests.
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Affiliation(s)
- Omar Khalid
- University of Chicago Childrens Hospital, Chicago, IL 60637, USA.
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5
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Riesenkampff EMC, Schmitt B, Schnackenburg B, Huebler M, Alexi-Meskishvili V, Hetzer R, Berger F, Kuehne T. Partial anomalous pulmonary venous drainage in young pediatric patients: the role of magnetic resonance imaging. Pediatr Cardiol 2009; 30:458-64. [PMID: 19184180 DOI: 10.1007/s00246-008-9367-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 12/22/2008] [Indexed: 11/25/2022]
Abstract
Studies of larger patient groups for systematic assessment of the anatomical accuracy of magnetic resonance imaging (MRI) for partial anomalous pulmonary venous drainage (PAPVD) have been performed so far only in adults. This study was undertaken to evaluate whether MRI can precisely depict pulmonary venous anatomy in infants and young children. Data on 26 children under 10 years old that underwent MRI over the past 2 years for suspected PAPVD were assessed. The MRI protocol included shunt quantification by velocity-encoded cine as well as morphological and functional assessment by multislice multiphase and contrast-enhanced MR techniques. MRI was performed in the compliant patient in breath-hold (n = 8; age range, 4.6-9.5 years) and in the noncompliant patient in conscious-sedation free breathing (n = 18; age range, 0.4 to 7.5 years). In 22 patients, PAPVD was diagnosed with MRI and confirmed during surgery. In four patients with large atrial septal defects not accessible to percutaneous closure, normal pulmonary venous return was demonstrated by MRI and confirmed during surgery. MRI under conscious sedation accurately specifies the anatomy of pulmonary veins in infants and small children. Therefore, we suggest performing MRI in patients with inconclusive transthoracic echocardiographic results in the preoperative assessment of PAPVD.
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6
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Brown DW, Gauvreau K, Powell AJ, Lang P, Colan SD, del Nido PJ, Odegard KC, Geva T. Cardiac Magnetic Resonance Versus Routine Cardiac Catheterization Before Bidirectional Glenn Anastomosis in Infants With Functional Single Ventricle. Circulation 2007; 116:2718-25. [PMID: 18025538 DOI: 10.1161/circulationaha.107.723213] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Routine preoperative catheterization is standard practice in patients with single-ventricle physiology before bidirectional Glenn anastomosis. Because catheterization is invasive and exposes patients to ionizing radiation, cardiac magnetic resonance (CMR) may be a safe and effective alternative.
Methods and Results—
We conducted a prospective, randomized, single-center clinical trial comparing catheterization with CMR in patients considered for bidirectional Glenn operation from February 2003 to June 2006. End points were frequency of adverse events of the preoperative evaluation and a composite score of clinically successful surgery. Of 92 eligible patients, 82 were enrolled on the basis of screening echocardiogram, fulfillment of inclusion criteria, and informed consent. Patients were randomized to catheterization (n=41) or CMR (n=41). There were no baseline differences between groups. Four treatment crossovers occurred, 3 to catheterization and 1 to CMR. Catheter interventions were performed in 17 patients (41%). Catheterization resulted in more minor adverse events (78% versus 5%;
P
<0.001), longer preoperative hospital stays (median, 2 versus 1 day;
P
<0.001), and higher hospital charges ($34 477 versus $14 921;
P
<0.001). There was 1 major adverse event in the CMR group (
P
=1.0). The operative course and frequency of postoperative complications were similar between the 2 groups. The proportion of patients who had a successful bidirectional Glenn operation was similar (71% versus 83%;
P
=0.3). At the 3-month follow-up, there were no differences in clinical status, oxygen saturation, or frequency of reinterventions.
Conclusions—
CMR is a safe, effective, and less costly alternative to routine catheterization in the evaluation of selected patients before bidirectional Glenn operation. Further studies are necessary to determine whether there are long-term benefits from transcatheter interventions in these patients.
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Affiliation(s)
- David W. Brown
- From the Departments of Cardiology (D.W.B., K.G., A.J.P., P.L., S.D.C., T.G.), Cardiovascular Surgery (P.J.d.N.), and Anesthesia (K.C.O.), Children’s Hospital Boston, Boston, Mass, and Departments of Pediatrics (D.W.B., K.G., A.J.P., P.L., S.D.C., T.G.), Surgery (P.J.d.N.), and Anesthesia (K.C.O.), Harvard Medical School, Boston, Mass
| | - Kimberlee Gauvreau
- From the Departments of Cardiology (D.W.B., K.G., A.J.P., P.L., S.D.C., T.G.), Cardiovascular Surgery (P.J.d.N.), and Anesthesia (K.C.O.), Children’s Hospital Boston, Boston, Mass, and Departments of Pediatrics (D.W.B., K.G., A.J.P., P.L., S.D.C., T.G.), Surgery (P.J.d.N.), and Anesthesia (K.C.O.), Harvard Medical School, Boston, Mass
| | - Andrew J. Powell
- From the Departments of Cardiology (D.W.B., K.G., A.J.P., P.L., S.D.C., T.G.), Cardiovascular Surgery (P.J.d.N.), and Anesthesia (K.C.O.), Children’s Hospital Boston, Boston, Mass, and Departments of Pediatrics (D.W.B., K.G., A.J.P., P.L., S.D.C., T.G.), Surgery (P.J.d.N.), and Anesthesia (K.C.O.), Harvard Medical School, Boston, Mass
| | - Peter Lang
- From the Departments of Cardiology (D.W.B., K.G., A.J.P., P.L., S.D.C., T.G.), Cardiovascular Surgery (P.J.d.N.), and Anesthesia (K.C.O.), Children’s Hospital Boston, Boston, Mass, and Departments of Pediatrics (D.W.B., K.G., A.J.P., P.L., S.D.C., T.G.), Surgery (P.J.d.N.), and Anesthesia (K.C.O.), Harvard Medical School, Boston, Mass
| | - Steven D. Colan
- From the Departments of Cardiology (D.W.B., K.G., A.J.P., P.L., S.D.C., T.G.), Cardiovascular Surgery (P.J.d.N.), and Anesthesia (K.C.O.), Children’s Hospital Boston, Boston, Mass, and Departments of Pediatrics (D.W.B., K.G., A.J.P., P.L., S.D.C., T.G.), Surgery (P.J.d.N.), and Anesthesia (K.C.O.), Harvard Medical School, Boston, Mass
| | - Pedro J. del Nido
- From the Departments of Cardiology (D.W.B., K.G., A.J.P., P.L., S.D.C., T.G.), Cardiovascular Surgery (P.J.d.N.), and Anesthesia (K.C.O.), Children’s Hospital Boston, Boston, Mass, and Departments of Pediatrics (D.W.B., K.G., A.J.P., P.L., S.D.C., T.G.), Surgery (P.J.d.N.), and Anesthesia (K.C.O.), Harvard Medical School, Boston, Mass
| | - Kirsten C. Odegard
- From the Departments of Cardiology (D.W.B., K.G., A.J.P., P.L., S.D.C., T.G.), Cardiovascular Surgery (P.J.d.N.), and Anesthesia (K.C.O.), Children’s Hospital Boston, Boston, Mass, and Departments of Pediatrics (D.W.B., K.G., A.J.P., P.L., S.D.C., T.G.), Surgery (P.J.d.N.), and Anesthesia (K.C.O.), Harvard Medical School, Boston, Mass
| | - Tal Geva
- From the Departments of Cardiology (D.W.B., K.G., A.J.P., P.L., S.D.C., T.G.), Cardiovascular Surgery (P.J.d.N.), and Anesthesia (K.C.O.), Children’s Hospital Boston, Boston, Mass, and Departments of Pediatrics (D.W.B., K.G., A.J.P., P.L., S.D.C., T.G.), Surgery (P.J.d.N.), and Anesthesia (K.C.O.), Harvard Medical School, Boston, Mass
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7
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Valsangiacomo Büchel ER, DiBernardo S, Bauersfeld U, Berger F. Contrast-enhanced magnetic resonance angiography of the great arteries in patients with congenital heart disease: an accurate tool for planning catheter-guided interventions. Int J Cardiovasc Imaging 2006. [PMID: 16015447 DOI: 10.1007/s10554-004-4017y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Catheter-guided interventions are increasingly used for relief of lesions in patients with congenital heart disease. Exact anatomical imaging with measurement of the vascular structures is crucial in the planning of such interventions. This can be provided non-invasively and without radiation by contrast-enhanced MR angiography (CE-MRA). AIM To evaluate the accuracy of the measurements of the vessels obtained by CE-MRA in comparison to those obtained by conventional X-ray angiography (XRA). METHODS Measurements of the diameters of aorta and pulmonary arteries were performed retrospectively and blinded on the CE-MRA and XRA images, in comparable locations. The limits of agreement between the two methods were calculated. RESULTS Twenty-one CE-MRA and XRA were performed in 20 children with congenital heart disease, median age 4 years (1 day-13 years), weight 18 kg (3.2-74 kg). The time interval between CE-MRA and XRA was 2.6 +/- 2.3 months. A total of 98 measurements, 38 of the aorta and 60 of the pulmonary arteries were performed on the images obtained by each technique. The correlation between CE-MRA and XRA measurements was excellent, r = 0.97, p < 0.0001. The mean difference between the two techniques was 0.018 +/- 1.1 mm; the limits of agreement -2.14 and + 2.18 mm. Similar agreement was found for measures of the aorta (r = 0.97, mean difference 0.20 +/- 1.08 mm) and of the pulmonary arteries (r = 0.97, mean difference 0.048 +/- 0.89 mm). CONCLUSIONS CE-MRA provides accurate quantitative anatomical information, which highly agrees with XRA data, and can therefore be used for planning catheter-guided procedures.
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8
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Valsangiacomo Büchel ER, DiBernardo S, Bauersfeld U, Berger F. Contrast-enhanced magnetic resonance angiography of the great arteries in patients with congenital heart disease: an accurate tool for planning catheter-guided interventions. Int J Cardiovasc Imaging 2005; 21:313-22. [PMID: 16015447 DOI: 10.1007/s10554-004-4017-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2004] [Accepted: 09/27/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Catheter-guided interventions are increasingly used for relief of lesions in patients with congenital heart disease. Exact anatomical imaging with measurement of the vascular structures is crucial in the planning of such interventions. This can be provided non-invasively and without radiation by contrast-enhanced MR angiography (CE-MRA). AIM To evaluate the accuracy of the measurements of the vessels obtained by CE-MRA in comparison to those obtained by conventional X-ray angiography (XRA). METHODS Measurements of the diameters of aorta and pulmonary arteries were performed retrospectively and blinded on the CE-MRA and XRA images, in comparable locations. The limits of agreement between the two methods were calculated. RESULTS Twenty-one CE-MRA and XRA were performed in 20 children with congenital heart disease, median age 4 years (1 day-13 years), weight 18 kg (3.2-74 kg). The time interval between CE-MRA and XRA was 2.6 +/- 2.3 months. A total of 98 measurements, 38 of the aorta and 60 of the pulmonary arteries were performed on the images obtained by each technique. The correlation between CE-MRA and XRA measurements was excellent, r = 0.97, p < 0.0001. The mean difference between the two techniques was 0.018 +/- 1.1 mm; the limits of agreement -2.14 and + 2.18 mm. Similar agreement was found for measures of the aorta (r = 0.97, mean difference 0.20 +/- 1.08 mm) and of the pulmonary arteries (r = 0.97, mean difference 0.048 +/- 0.89 mm). CONCLUSIONS CE-MRA provides accurate quantitative anatomical information, which highly agrees with XRA data, and can therefore be used for planning catheter-guided procedures.
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Mavroudis C, Backer CL, Stewart RD, Heraty P. The case against minimally invasive cardiac surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2005:193-7. [PMID: 15818378 DOI: 10.1053/j.pcsu.2005.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Stellar outcomes have been achieved for patent ductus arteriosus (PDA), atrial septal defect (ASD), and ventricular septal defect (VSD) repairs by using the traditional surgical methods. Over the last decade, minimally invasive procedures have been introduced that promise excellent results with an improved cosmetic appearance, shorter rehabilitation period, less pain, and decreased hospital cost. We reviewed various minimally invasive procedures that are used in PDA, ASD, and VSD to assess their safety and efficacy. These techniques use limited approaches to the heart (partial sternotomies, transxiphoid, anterolateral thoracotomy, and mini-thoracotomy) that reduce the surgeons access and control of the cardiac structures. Cannulation sites for the establishment of cardiopulmonary bypass have been altered. Minimally invasive therapies for congenital heart surgery cannot be adopted until evidence-based data has proven them to be equal or better than the traditional procedure.
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Affiliation(s)
- Constantine Mavroudis
- Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Chicago, IL 60614, USA
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10
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Dorfman AL, Levine JC, Colan SD, Geva T. Accuracy of echocardiography in low birth weight infants with congenital heart disease. Pediatrics 2005; 115:102-7. [PMID: 15629988 DOI: 10.1542/peds.2004-0147] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Echocardiography has been shown to be highly accurate in infants and children, but its accuracy has not been studied in detail in low birth weight (LBW) infants with structural congenital heart disease (CHD). This study was undertaken to examine the diagnostic accuracy of echocardiography in the evaluation of CHD in these infants. METHODS All echocardiograms performed between 1995 and 2000 on infants who had structural CHD and weighed <or=2.5 kg were reviewed (n = 251). Infants who weighed >2.5 kg, matched for type of CHD, were control subjects (n = 319). The results of initial echocardiograms were compared for diagnostic accuracy with consensus diagnoses on the basis of all confirmatory data available. An observer who was blinded to patient group graded a sample of randomly selected echocardiograms (n = 100) for technical quality. RESULTS There were 13 major diagnostic errors in the LBW infants (5.2%) and 6 in the control subjects (1.9%). There were 20 minor errors in the LBW group (8.0%) and 21 in the control subjects (6.6%). The technical quality scores of the 2 groups were not significantly different, but a higher proportion of the LBW studies were graded as "poor" or "borderline" quality, compared with the control subjects (40% vs 28%). The majority (54%) of major errors in the LBW infants could potentially be explained by alterations in blood flow secondary to pulmonary hypertension. CONCLUSIONS Although echocardiography is an accurate imaging modality in premature and LBW infants with structural CHD, the incidence of clinically important diagnostic errors is higher than in infants who weigh >2.5 kg. As surgical and transcatheter interventions are extended to this population, heightened awareness of clinicians to pitfalls of echocardiography in this group of patients is warranted.
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Affiliation(s)
- Adam L Dorfman
- Department of Cardiology, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA
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11
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ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: Summary Article. J Am Soc Echocardiogr 2003. [DOI: 10.1016/j.echo.2003.08.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Cheitlin MD, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davis JL, Douglas PS, Faxon DP, Gillam LD, Kimball TR, Kussmaul WG, Pearlman AS, Philbrick JT, Rakowski H, Thys DM. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). J Am Coll Cardiol 2003; 42:954-70. [PMID: 12957449 DOI: 10.1016/s0735-1097(03)01065-9] [Citation(s) in RCA: 341] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Cheitlin MD, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davis JL, Douglas PS, Faxon DP, Gillam LD, Kimball TR, Kussmaul WG, Pearlman AS, Philbrick JT, Rakowski H, Thys DM, Antman EM, Smith SC, Alpert JS, Gregoratos G, Anderson JL, Hiratzka LF, Hunt SA, Fuster V, Jacobs AK, Gibbons RJ, Russell RO. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). Circulation 2003; 108:1146-62. [PMID: 12952829 DOI: 10.1161/01.cir.0000073597.57414.a9] [Citation(s) in RCA: 611] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Brown DW, Gauvreau K, Moran AM, Jenkins KJ, Perry SB, del Nido PJ, Colan SD. Clinical outcomes and utility of cardiac catheterization prior to superior cavopulmonary anastomosis. J Thorac Cardiovasc Surg 2003; 126:272-81. [PMID: 12878965 DOI: 10.1016/s0022-5223(03)00054-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We sought to characterize the outcomes of routine catheterization prior to superior cavopulmonary anastomosis and to determine if some patients were unlikely to benefit from catheterization and thus might be evaluated preoperatively with noninvasive methods alone. BACKGROUND Congenital heart disease patients with single ventricle physiology undergo routine echocardiography and cardiac catheterization prior to superior cavopulmonary anastomosis to determine anatomic and hemodynamic suitability for this procedure. METHODS We performed a retrospective review of all infants (n = 114) evaluated for potential superior cavopulmonary anastomosis at our institution from January 1997 to June 2000. RESULTS Patients' median age was 5.5 months. Full echocardiograms were obtained in 79 patients (69%). At catheterization a total of 41 interventions were performed in 35 patients (31%). Twenty-seven patients (24%) were transfused, 18 patients (17%) required cardiac intensive care unit admission, and median length of stay following catheterization was 1 day (range 0 to 22). Complications occurred in 28 patients (25%), most transient. Of 51 patients who had complete echocardiograms without indication for catheterization, none subsequently had significant interventions and only 2 had new findings at catheterization. Three candidates were excluded from operation; all 111 others underwent successful procedures and survived to hospital discharge. CONCLUSIONS Interventions were frequent at catheterization prior to superior cavopulmonary anastomosis, but transient complications, transfusion, intensive care unit admission, and prolonged hospital length of stay were common. For patients in whom no issues indicating need for catheterization are identified by echocardiogram, routine catheterization rarely results in new information or intervention. These patients may be more safely evaluated preoperatively using exclusively noninvasive techniques.
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Affiliation(s)
- David W Brown
- Department of Cardiology, Children's Hospital, Boston, MA 02115, USA.
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