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.