Impact of Accuracy of Preoperative Transthoracic Echocardiography on Complex Congenital Heart Surgery in Pediatrics

Abstract

Objective: In simple congenital heart disease, transthoracic echocardiography for the diagnosis and preoperative evaluation is an effective investigation. But its role in complex congenital heart disease is yet to be proven. The aim of this study was to find an accuracy ratio of preoperative echocardiography in complex congenital heart disease and the effect of non-equivalent findings to surgical plan and outcomes.
Methods: Medical records of complex congenital heart disease patients who underwent open heart surgery during 2013 -2015, including echocardiographic reports, operative notes, in-patient and out-patient data were retrospectively reviewed. Patients who underwent palliative shunt procedure, age > 15 year and missing data were excluded. A total of 300 patients were included in the study. We used intraoperative findings as a gold standard to compare with preoperative transthoracic echocardiography. Then, we analyzed data comparing between groups of patients who had concordant and non-concordant echocardiographic finding. After that we compared between groups of patients who had surgery changed from the preoperative plan and those who had not. SPSS version 18 was used to analyze.
Results: The concordance of preoperative echocardiography was 77.7%. In the non-concordant data group, approximately one third had to change the plan of operation and about one tenth had to change cannulation technique. Most of non-concordance were that of systemic venous drainage and coronary artery pattern. But it had no significant effect to surgical outcomes including operative time, cardiopulmonary bypass time, morbidity and mortality rate.
Conclusion: Transthoracic echocardiography is valuable tool that give a lot of details on anatomical and physiological data in congenital heart disease. However, some complex congenital heart patients may need additional investigations such as cardiac catheterization, CT scan, Cardiac MRI in order to obtain adequate anatomical and physiological data for surgical planning.