Hypoplastic left heart syndrome: Is echocardiography accurate enough to guide surgical palliation?

Abstract

Two-dimensional echocardiography can diagnose hypoplastic left heart syndrome. However, with the advent of the possibility of palliative open heart surgery, complete anatomic diagnosis is necessary. The anatomic findings of 15 neonates with hypoplastic left heart syndrome (age 1 to 10 days, mean 4.1) who had two-dimensional Doppler echocardiographic studies were compared with the results obtained by angiography (6 cases), surgery (11 cases) and autopsy (8 cases). Complete two-dimensional echocardiographic examination of the aortic arch, pulmonary and systemic venous return, atrial septum, ductus arteriosus and proximal coronary arteries was possible in all 15 neonates and correctly diagnosed hypoplastic left heart syndrome in each. Anatomic two-dimensional echocardiographic assessment was accurate in 13 (86%) of the 15 neonates and there were no false positive results. Undiagnosed associated abnormalities were hypoplasia of a left pulmonary artery in one patient and left superior vena cava in another. Accurate quantitation of the size of the tricuspid valve anulus, ascending aorta, pulmonary anulus and right and left pulmonary arteries was possible. Doppler examination was performed in seven patients and confirmed retrograde aortic arch flow and right to left systolic shunting in the patent ductus arteriosus. In selected neonates, surgical palliation can be attempted without angiography.

Diagnostic assessment before Fontan operation in patients with bidirectional cavopulmonary anastomosis

“…Echocardiography is also commonly used as the sole diagnostic modality before the first palliative procedure in patients with single-ventricle lesions (6,7). Diagnostic evaluation before Fontan procedure has typically included noninvasive assessment with echocardiography as well as invasive hemodynamic and angiographic evaluation by cardiac catheterization (8,9).…”

O papel do ecocardiograma como método isolado na indicação cirúrgica de pacientes portadores de cardiopatia congênita

“…Em muitos serviços, o ecocardiograma tornou-se método de primeira linha no estudo pré-operatório, ficando o cateterismo reservado para complementação diagnóstica. Entretanto, ainda é controversa na literatura a indicação cirúrgica sem estudo invasivo para todos os casos de defeito cardíaco complexo [6][7][8][9][10][11][12][13][14][15] , conduta aceita por algumas instituições apenas para os casos de defeitos simples, como lesões isoladas com shunt intracardíaco e cardiopatias apresentando fisiologia de ventrículo único, que necessitam de cirurgia paliativa.…”

Diretriz para Indicações e Utilização da Ecocardiografia na Prática Clínica

“…O principal papel do exame está na completa caracterização da lesão de pacientes com suspeita clínica, na avaliação da história natural, no reconhecimento e na prevenção de mudanças secundárias, assim como na resposta ao tratamento dispensado [85][86][87][88][89][90][91][92][93][94][95][96] .…”