7-YEAR EXPERIENCE OF NONINVASIVE PREOPERATIVE DIAGNOSTICS IN CHILDRENWITH CONGENITAL HEART-DEFECTS - COMPREHENSIVE ANALYSIS OF 2,788 CONSECUTIVE PATIENTS

The spectrum of patients operated on without preoperative catheterizat ion and angiography, the accuracy of echocardiographic diagnosis and i ts impact on the results of surgical treatment were prospectively asse ssed in 2,788 children consecutively operated for congenital heart def ects (CHD) between 1986 and 1992. The overall percentage of surgery ba sed solely on noninvasive pre operative examination increased from 63% in 1986 to 81% in 1990 and decreased to 72% in 1992. There were no di fferences in the preoperative diagnostic approach between groups of ne wborn, infants and children. A high percentage of patients with patent ductus arteriosus (96.5%), atrial septal defect (94%), incomplete atr ioventricular septal defect (88.6%), ventricular septal defect (86.3%) , coarctation of the aorta (80.2%) and total anomalous pulmonary venou s connection (79.3%) was referred for surgery without prior invasive e xamination, while a lower percentage was found in univentricular heart (48.4%), pulmonary atresia (34.6%) and double outlet right ventricle (27.7%). More patients with pulmonary and tricuspid atresia were cathe terized before complete repair compared to those who underwent palliat ive surgery (p < 0.01 and p < 0.0001, respectively). The echocardiogra phic diagnosis was correct in 96% of patients. Two patients of those w ith incomplete preoperative diagnosis died early postoperatively, both with missed apical ventricular septal defect. One with tetralogy of F allot died after reoperation, the other with persistent truncus arteri osus due to sepsis. When the echocardiographic findings are in full ag reement with the clinical status, physical examination, ECG and chest X-ray, we recommed cardiac surgery without prior catheterization in ma ny patients with CHD.