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COLOUR DOPPLER ECHOCARDIOGRAPHY IN THE MANAGEMENT OF CONGENITAL HEART DISEASE.

ABSTRACT: Twenty patients with various forms of congenital heart disease admitted to Army Hospital Delhi Cantt were studied. After detailed clinical examination and routine investigations they were subjected to two dimensional and subsequently colour Doppler echocardiography. Two patients were operated on the data obtained by echocardiographi. studies only. Seven patients required preoperative catheterisation in addition to echographic examination. The operative procedures confirmed the lesions delineated on colour Doppler echocardiography. Three patients are on echocardiographic review and remaining seven are awaiting surgery to further confirm the diagnosis offered on colour Doppler echo. One pateint of complex lesion died before detailed evaluation could be carried out. Thus colour Doppler echocardiography, though considered highly accurate and non invasive investigation for assessment of congenital heart disease is still in the stage of infancy in paediatric set up and requires a high degree of expertise before it can replace preoperative catheterisation in majority of cases.

SUBMITTER: Vatwani V

PROVIDER: S-EPMC5529685 | biostudies-other | 1994 Jan

REPOSITORIES: biostudies-other

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Project description:PurposeTo apply Doppler US (DUS)-gated fetal cardiac cine MRI in clinical routine and investigate diagnostic performance in complex congenital heart disease (CHD) compared with that of fetal echocardiography.Materials and methodsIn this prospective study (May 2021 to March 2022), women with fetuses with CHD underwent fetal echocardiography and DUS-gated fetal cardiac MRI on the same day. For MRI, balanced steady-state free precession cine images were acquired in the axial and optional sagittal and/or coronal orientations. Overall image quality was assessed on a four-point Likert scale (from 1 = nondiagnostic to 4 = good image quality). The presence of abnormalities in 20 fetal cardiovascular features was independently assessed by using both modalities. The reference standard was postnatal examination results. Differences in sensitivities and specificities were determined by using a random-effects model.ResultsThe study included 23 participants (mean age, 32 years ± 5 [SD]; mean gestational age, 36 weeks ± 1). Fetal cardiac MRI was completed in all participants. The median overall image quality of DUS-gated cine images was 3 (IQR, 2.5-4). In 21 of 23 participants (91%), underlying CHD was correctly assessed by using fetal cardiac MRI. In one case, the correct diagnosis was made by using MRI only (situs inversus and congenitally corrected transposition of the great arteries). Sensitivities (91.8% [95% CI: 85.7, 95.1] vs 93.6% [95% CI: 88.8, 96.2]; P = .53) and specificities (99.9% [95% CI: 99.2, 100] vs 99.9% [95% CI: 99.5, 100]; P > .99) for the detection of abnormal cardiovascular features were comparable between MRI and echocardiography, respectively.ConclusionUsing DUS-gated fetal cine cardiac MRI resulted in performance comparable with that of using fetal echocardiography for diagnosing complex fetal CHD.Keywords: Pediatrics, MR-Fetal (Fetal MRI), Cardiac, Heart, Congenital, Fetal Imaging, Cardiac MRI, Prenatal, Congenital Heart DiseaseClinical trial registration no. NCT05066399 Supplemental material is available for this article. © RSNA, 2023See also the commentary by Biko and Fogel in this issue.

Project description:BACKGROUND:Left-sided congestive heart failure (CHF) is characterized by increased filling pressures and related Doppler echocardiographic (DE) filling patterns. HYPOTHESIS:Doppler echocardiographic variables of left ventricular filling derived from transmitral flow, pulmonary vein flow, and tissue Doppler can be used to detect CHF in cats with hypertrophic cardiomyopathy (HCM). ANIMALS:Forty-seven client-owned cats. METHODS:Prospective clinical cohort study. Cats underwent physical examination, thoracic radiography, analysis of N-terminal pro-brain natriuretic peptide (NT-proBNP), and transthoracic echocardiography and were divided into 3 age-matched groups: Group 1 (apparently healthy control), Group 2 (preclinical HCM), and Group 3 (HCM and CHF). Measured and calculated variables included respiratory rate, DE estimates, serum NT-proBNP concentration, and radiographic CHF score. Groups were compared using ANOVA, and receiver operating characteristic (ROC) curve and multivariate analyses were used to identify diagnostic cutoffs for the detection of CHF. RESULTS:Fifteen cats were in Group 1, 17 in Group 2, and 15 in Group 3. The ROC analysis indicated that the ratio of peak velocity of early diastolic transmitral flow to peak velocity of late diastolic transmitral flow (area under the curve [AUC], 1.0; diagnostic cutoff, 1.77; P =?.001), ratio of left atrial size to aortic annular dimension (AUC, 0.91; diagnostic cutoff, 1.96; P =?.003), left atrial diameter (AUC, 0.89; cutoff, 18.5?mm; P =?.004), diastolic functional class (AUC, 0.89; cutoff, class 2; P =?.005), respiratory (AUC, 0.79; cutoff, 36 breaths per minute [brpm]; P =?.02), and the ratio of the peak velocity of fused early and late transmitral flow velocities to the peak velocity of the fused early and late diastolic tissue Doppler waveforms (AUC, 0.74; cutoff, 15.1; P =?.05) performed best for detecting CHF. CONCLUSIONS AND CLINICAL IMPORTANCE:Various DE variables can be used to detect CHF in cats with HCM. Determination of the clinical benefit of such variables in initiating treatments and assessing treatment success needs further study.

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COLOUR DOPPLER ECHOCARDIOGRAPHY IN THE MANAGEMENT OF CONGENITAL HEART DISEASE.

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