Does color flow mapping Doppler echocardiography allow the catheterization laboratory to be bypassed in surgery of congenital heart disease?

Abstract

The purpose of this study is to demonstrate the clinical usefulness of color flow mapping real-time two-dimensional Doppler echocardiography (2-D Doppler) in establishing the diagnosis of congenital heart disease (CHD) and its application for intraoperative use. In the past two years we examined a series of 278 patients (pts) with CHD including 97 infants and 105 children. With this device, real-time two-dimensional intracardiac and major vascular blood flow images on B-mode echocardiography have been clearly displayed by red color (flow towards the transducer) and blue color (flow away from the transducer) mixed with green color (variance of blood flow velocity) and graded brightness (average blood flow velocity). Patients suffered from ASD (75 pts), VSD (76 pts), TOF (23 pts), TGA (12 pts), PDA (23 pts), ECD (13 pts), PS (13 pts) or miscellaneous CHD, (47 pts). These diagnoses were confirmed by cardiac catheterization and/or surgery with the exception of PDA in premature infants. In 271 patients (97%) abnormal intracardiac blood flow (shunt flow, stenotic flow, and regurgitant flow) was clearly visualized by 2-D Doppler. In 31 patients several palliative procedures (Blalock-Taussig shunt operation: 8, Brock operation: 2, pulmonary arterial banding: 10, BAS: 11) were performed mostly based on 2-D Doppler diagnosis. Fifteen premature infants with PDA and respiratory failure were followed up using 2-D Doppler during Sulindac (prostaglandin antagonist) therapy and 3 infants resistent to Sulindac therapy underwent surgery. In 10 patients intraoperative 2-D Doppler evaluations were performed for confirmation of the diagnosis, confirmation of the completeness of surgery, and for 2-D Doppler echo guided blade atrioseptostomy by direct right atrial approach in the case of d-TGA with bilateral iliac venous obstraction. In conclusion, 2-D Doppler diagnosis was satisfactory in about 90% of corrective surgical cases. Therefore, 2-D Doppler can be a useful non-invasive diagnostic tool for CHD. Also, 2-D Doppler is effective for intraoperative evaluation of multiple cardiac abnormalities in complex CHD and for confirmation of the completeness of surgery. It is suggested that surgery can be carried out without cardiac catheterization in a significant number of congenital heart diseases.