Abstract 15892: Reliability of Focused Cardiac Ultrasound in the Post-Operative Assessment of Patients With Congenital Heart Disease: A Single Center Experience

Abstract

Introduction: Early detection of postoperative complications in children with congenital heart disease (CHD) is crucial. The utility of focused cardiac ultrasound (FoCUS) in the assessment of post-operative congenital cardiac surgical patients is not known. Objective: To evaluate the reliability of FoCUS in the assessment of children with CHD in the early post-operative period. Methods: A prospective observational cross-sectional study was performed in a single pediatric center. All FoCUS studies were performed by one imager within two hours of the paired echocardiographic (ECHO) study performed by a different imager. FoCUS studies were obtained using Philips Lumify R and ECHO studies utilized a high-end ultrasound machine (Philips Affiniti R ). Qualitative ventricular (right and left) function, pericardial effusion, pleural effusion, and degree of mitral regurgitation (MR) and tricuspid regurgitation (TR) were compared. All FoCUS and ECHO studies were sent for review in a random and blinded fashion to two independent noninvasive imaging cardiologists. Weighted k statistics were used to determine the level of agreement between FoCUS and ECHO, and between observers. Results: Twenty-three FoCUS studies were performed in 12 patients with a mean age of 16.6 months (range 0-96 months) within two weeks postoperatively. There was inter-observer agreement for ECHO on all parameters and inter-observer agreement for FoCUS on all parameters except for TR. The intra-observer agreement between FoCUS and ECHO for the two cardiologists was fair to moderate for ventricular function (k= 0.470, p< 0.05 and 0.340, p < 0.05), substantial for pericardial effusion (k = 0.617, p< 0.05 and 0.777, p< 0.05), and fair for MR (0.400, p< 0.05). There was no statistically significant agreement for TR and pleural effusion for both observers and MR for one observer. Conclusions: FoCUS demonstrated acceptable reliability in the assessment of ventricular function and presence of pericardial effusions, with a limited value in the assessment of atrioventricular valve regurgitation. This tool is valuable in the early post-operative evaluation of pediatric patients with congenital heart disease in the cardiac intensive care unit.