Paediatric follow‐up of haemodynamically insignificant congenital cardiac lesions

Abstract

The increasingly sensitive and advanced nature of echocardiography and the subsequent reliance upon it may be contributing to unnecessarily frequent review of HICCL and a reluctance to discharge patients. In the majority of patients with HICCL, no more than two assessments of HICCL are required after 2 years of age - once in late childhood and once near full growth.

Controversies in the definition and management of insignificant left-to-right shunts

“…Interestingly, the reported closure rate in some studies9 11 12 is discordant with the reported 25% prevalence of PFOs from other studies 2 55…”

“…Patient age and the presence of symptoms are also important determinants in the frequency of follow-up in this study. Another survey from the UK reveals that, for children over 3 years old with an ASD and a normal right heart, 60% of physicians recommend follow-up every 3 years, 25% recommend follow-up every 5 years, and many recommend discharge in late adolescence 2. By contrast, for children over 5 years old with an incidental PFO, 81% recommend immediate discharge accompanied by a discussion of the implications of scuba diving.…”

“…Some authors have defined small VSDs as having diameters <3 mm by echocardiography,26 but other definitions have been published using other modalities 27. Normal pulmonary artery pressures and left heart size from echocardiography and a normal electrocardiogram are other criteria used to define small defects 2. Many studies have revealed a benign natural history for most VSDs 10 21–23 25 27 32–36.…”

“…An innocent congenital heart disease (CHD) is an anatomic variant that cannot be classified as either physiologic or pathologic 1 2. Examples include a small atrial septal defect (ASD) or patent foramen ovale (PFO), small ventricular septal defect (VSD), and small patent ductus arteriosus (PDA) 1 3 4.…”

“…More recent publications have recommended different management approaches. For example, many paediatric cardiologists follow patients with small ASDs regularly,2 18 and some advocate for closure of all PDAs 42 45. Not surprisingly, unnecessary follow-up and treatment have important consequences in terms of cost, human resources and parental anxiety 2 46 53 54…”