Do We Need More Than Transthoracic Echocardiography Before Cardiac Surgery For Children With CHD Muna Ismail, MRCPCH; Fahad Alhabshan, MD FESC, Mohammed Ghamdi, MD FRCPC Pediatric Cardiology King Abdulaziz Cardiac Center National Guard Health Affair
Introduction ď ą
Children with CHD who require surgical intervention form a diagnostic challenge
ď ą
Require detailed understanding of anatomy , physiology and morphological feature of their CHD
Introduction
Careful assessment of defects and associated lesions proper planning for surgical intervention improves outcome
Morbidity & Mortality can result from prolongation of surgical procedure and cardio-pulmonary bypass time to explore and repair undiagnosed defects
Introduction ď ą
Echo is the Non invasive imaging modality of choice for diagnosis and follow up of children with CHD
ď ą
Reliable in diagnosing almost all types of CHD (major diagnostic errors : o.2 - 2%) Circ Cardiology Imaging 2010; 3: 112-125
Objectives Determine if transthoracic echo can be used as the sole diagnostic imaging modality for CHD before cardiac surgery ď ą Check other diagnostic techniques used ď ą Verify the diagnostic accuracy of Transthoracic echo compared to surgical findings ď ą
Methodology
Retrospective Cohort All pediatric patients with CHD who underwent cardiac surgery at KACC January 2011 - December 2011 Cardiac and hospital data base reviewed For diagnostic modalities used before cardiac surgery Indications for other diagnostic modalities evaluated
Exclusion criteria
Exclusion Criteria: Pacemaker
insertion PPM battery change Exploration Bleeding Sternal closure Non-cardiovascular repair
General diagnostic algorithm Suspected CHD
Transthoracic Echo
Evaluation is complete for decision making ?
No
Other Imaging Modalities
Yes
No further test
OR
Results Examples of cardiac surgery
Demographic Data ( Mean ± SD )
Wt: 10.15 + 9.33 kg Males: 50%, Females: 50% Number of Echo before surgery : 3.44 ± 2.94
Results 73%
27%
Additional Modality
64% 35%
Indication for cardiac catheterization
79%
21%
Indication for cardiac catheterization Hemodynamic PA
pressure Reactivity of PHT
53 42 (79%) 11 (21%)
CT Angio 35 30 25 20
31
15 10 5 0
5 Confirmatory Findi ng
New Diagnostic Finding
Results 70%
73 30% 31
Results
Diagnostic Modality before Sx: Echo Cath CT MRI
Alone
288 67 36 1
7 ( 2%) : Intra-op additional finding (Minor)
Results 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
81%
19% ECHO enough
ECHO not enough
Echo Enough
Echo Needs Confirmation
Echo Needs Confirmation
CT Confirmatory
Echo Not Enough
Echo Not Enough
Discussion Majority of our patients went for cardiac surgery based on Echo alone (73%) Other imaging modalities added mainly confirmatory information Inherent Echo limitation:
PA
pressure assessment Extracardiac vascular anomalies (MAPCAS, PAPVD, Complex Arch ,..etc)
Discussion
Conclusion ď ą
Transthoracic echo can be Sole diagnostic modality for pre-op assessment in majority of CHD patients
ď ą
Other modality can be used with limited indications
Thank You