SHA24/055004

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