Author + information
- Received August 4, 1986
- Revision received October 21, 1986
- Accepted November 20, 1986
- Published online April 1, 1987.
- James C. Huhta, MD, FACC**,1,*,
- Patrick Glasow, MD†,
- Daniel J. Murphy Jr., MD*,
- Howard P. Gutgesell, MD, FACC‡,
- David A. Ott, MD, FACC§,
- Dan G. McNamara, MD, FACC* and
- E. O'brian Smith, PhD‖
- ↵*Address for reprints: James C. Huhta, MD, Pediatric Cardiology, 1-253, Texas Children's Hospital, 6621 Fannin Street, Houston, Texas 77030.
Little information is available regarding the surgical mortality of children with congenital heart disease who undergo operation on the basis of clinical assessment and echocardiographic diagnosis without cardiac catheterization. If catheterization affects early surgical mortality then perhaps omitting it would improve survival. Early operative mortality of 100 patients managed with echocardiography without preoperative catheterization (Group I) was compared with that of 151 diagnosis-matched control patients who had catheterization (Group II). The catheterization (Group II) and echocardiographic (Group I) groups included patients with the following diagnoses: atrial septal defect (33 and 17 in Group II and Group I, respectively); pulmonary stenosis/pulmonary atresia (33 and 15), aortic stenosis (14 and 3), coarctation of aorta (36 and 29), patent ductus arteriosus (10 and 15) and miscellaneous (25 and 21). Age range was 1 day to 16 years (mean 3.5); 114 (45%) of the 251 patients were <1 year of age and 59 (29%) were <1 month of age. With one exception, echocardiographic diagnosis was correct when compared with findings at surgery or autopsy, or both. Surgical mortality was 18% in Group I and 9% in Group II; however, multiple logistic regression analysis adjusting for differences in age and preoperative condition showed no significant difference between the two groups with a trend toward lower mortality in Group I (p = 0.075).
Echocardiography as the definitive imaging modality in selected patients with congenital heart disease is accurate and is comparable with conventional methods of preoperative diagnosis. The surgical mortality of patients with such defects is not affected significantly by the method of diagnosis but individual patients may be in much better condition without angiography. The critically ill neonate and the older child with a congenital heart defect can be managed without catheterization provided the requisite skills in ultrasound imaging and the diagnostic experience are available.
- Received August 4, 1986.
- Revision received October 21, 1986.
- Accepted November 20, 1986.
- American College of Cardiology Foundation