DIAGNOSIS OF CONGENITAL CARDIAC DEFECTS IN THE NEWBORN PERIOD: THE ROLE OF CARDIAC CATHETERIZATION

Abstract

In 30,000 consecutive deliveries from July, 1981 to July 1983, 65 infants with symptomatic congenital heart defects (CHD) and 138 infants with Nonstructural Heart Disease (Ischemic Myocardial Dysfunction, Persistent Fetal Circulation, Hypertrophic Cardiomyopathy) were encountered during the immediate newborn period (<2 wks of age). In addition to routine evaluation (physical exam, ECG, and chest x-ray), two-dimensional and M-mode echocardiograms, transcutaneous oxygen monitoring, and single film aortograms indicated the correct diagnosis in all except one infant with CHD and in all infants with Nonstructural Heart Disease (NSHD). Cardiac Catheterization (CC) during the newborn period was required only in 9 with CHD (14%) and in none with NSHD for correct diagnosis. CC was performed in 3 infants with transposition of the great vessels mainly for balloon atrial septostomy and in 6 infants for better definition of their intracardiac defects. Of 65 infants with CHD, 19 underwent palliative or corrective cardiac surgery. In only 5 infants (26%) was CC judged necessary prior to their initial surgery. In summary, noninvasive or semi-invasive bedside procedures are both sensitive and specific for making the correct diagnosis of CHD during the newborn period. Only in a small number of cases is CC required prior to initial cardiac surgery. In light of this and other similar studies, the indications for CC in symptomatic neonates with CHD should be reevaluated.