Pediatric cardiac surgery after exclusively echocardiography-based diagnostic work-up

This study was performed to evaluate the accuracy of exclusively non-invasi ve preoperative diagnostic work-up based on echocardiography and to assess the safety of cardiac surgery using this diagnostic approach in children wi th heart disease. During a 3.5-year period, accuracy of preoperative (invas ive and non-invasive) diagnostic work-up was prospectively tested by compar ison with the intraoperative findings obtained by surgical inspection and t ransoesophageal echocardiography. Included were all consecutive 358 childre n undergoing cardiac surgery (except pulmonary artery bandings and ductus L igations) during the study period at our institution. Of the patients, 44% were operated on in infancy, 84% of procedures were on cardiopulmonary bypa ss. Echocardiography as the only preoperative imaging modality was used in 231 patients (65%), in the other children, a diagnostic catheter was done. Diagnostic errors occurred in 3.9% (n=5) of patients after diagnostic cathe ter and in 6.9% (n=16) of patients with echocardiography only. Major diagno stic errors (resulting in prolongation of cardiac bypass time) were observe d at equal frequency in both groups (1.7% or four children in the echo-only group and 1.6% or two patients in the catheter group). In no case was the outcome affected by the previously unrecognized findings. It was shown that diagnostic cardiac catheterization could be avoided in a majority of pedia tric patients prior to surgical palliation or correction of cardiac defects , without increasing the risk of complications or the overall outcome. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.