Does color flow mapping Doppler echocardiography allow the catheterization laboratory to be bypassed in surgery of congenital heart disease?
The purpose of this study is to demonstrate the clinical usefulness of color flow mapping real-time two-dimensional Doppler echocardiography (2-D Doppler) in establishing the diagnosis of congenital heart disease (CHD) and its application for intraoperative use. In the past two years we examined a series of 278 patients (pts) with CHD including 97 infants and 105 children. With this device, real-time two-dimensional intracardiac and major vascular blood flow images on B-mode echocardiography have been clearly displayed by red color (flow towards the transducer) and blue color (flow away from the transducer) mixed with green color (variance of blood flow velocity) and graded brightness (average blood flow velocity). Patients suffered from ASD (75 pts), VSD (76 pts), TOF (23 pts), TGA (12 pts), PDA (23 pts), ECD (13 pts), PS (13 pts) or miscellaneous CHD, (47 pts). These diagnoses were confirmed by cardiac catheterization and/or surgery with the exception of PDA in premature infants. In 271 patients (97%) abnormal intracardiac blood flow (shunt flow, stenotic flow, and regurgitant flow) was clearly visualized by 2-D Doppler. In 31 patients several palliative procedures (Blalock-Taussig shunt operation: 8, Brock operation: 2, pulmonary arterial banding: 10, BAS: 11) were performed mostly based on 2-D Doppler diagnosis. Fifteen premature infants with PDA and respiratory failure were followed up using 2-D Doppler during Sulindac (prostaglandin antagonist) therapy and 3 infants resistent to Sulindac therapy underwent surgery. In 10 patients intraoperative 2-D Doppler evaluations were performed for confirmation of the diagnosis, confirmation of the completeness of surgery, and for 2-D Doppler echo guided blade atrioseptostomy by direct right atrial approach in the case of d-TGA with bilateral iliac venous obstraction. In conclusion, 2-D Doppler diagnosis was satisfactory in about 90% of corrective surgical cases. Therefore, 2-D Doppler can be a useful non-invasive diagnostic tool for CHD. Also, 2-D Doppler is effective for intraoperative evaluation of multiple cardiac abnormalities in complex CHD and for confirmation of the completeness of surgery. It is suggested that surgery can be carried out without cardiac catheterization in a significant number of congenital heart diseases.
KeywordsCongenital Heart Disease Kawasaki Disease Cardiac Catheterization Patent Ductus Arteriosus Atrial Septal Defect
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- 1.Omoto R, Yokote Y, Takamoto S, Kyo S, Ueda K, Asano H, Namekawa K, Kasai C, Kondo Y, Koyano A: The development of real-time two-dimensional Doppler echocardiography and its clinical significance in acquired valvular disease. With special reference to the evaluation of valvular regurgitation. Jpn Heart J 25: 325–340, 1984.PubMedCrossRefGoogle Scholar
- 2.Omoto R (ed.): Color atlas of real-time two-dimensional Doppler echocardiography. Tokyo: Shindan-to-Chiryo, 1984 (distributed Lea & Febiger, Philadelphia).Google Scholar
- 3.Kyo S, Omoto R, Takamoto S, Takanawa E: Quantitative estimation of intracardiac shunt flow in atrial septal defect by real-time two-dimensional color flow Doppler. Circulation 70 (Suppl II): 11–39, 1984.Google Scholar
- 4.Kyo S, Takamoto S, Ueda K, Emoto H, Tamura F, Asano H, Yokote Y, Omoto R, Takanawa E: Clinical significance of newly developed real-time two-dimensional Doppler echocardiography (2-D Doppler) in congenital heart diseases. With special reference to the assessment of intracardiac shunts. Proceedings of JSUA 43: 465–466, 1983.Google Scholar
- 5.Kyo S, Omoto R, Takamoto S, Ueda K, Emoto H, Asano H, Yokote Y: Real-time two- dimensional Doppler echocardiography (2-D Doppler) in congenital heart disease. Its clinical significance. J Cardiography 14: 785–801, 1984.Google Scholar
- 6.Kyo S, Omoto R, Takamoto S, Takanawa E: Clinical significance of color flow mapping real-time two-dimensional Doppler echocardiography (2-D Doppler) in congenital heart disease. Circulation 70 (Suppl II): 11–37, 1984.Google Scholar
- 8.Takamoto S, Kondo Y, Yoshikawa Y, Kasai C, Koyano A, Kyo S, Yokote Y, Omoto R: The first clinical experience of intraoperative real-time two-dimensional Doppler echocardiography in the dissecting aneurysm of the aorta. Proceedings of AIUM 29: 167, 1984.Google Scholar
- 9.Takamoto S, Kyo S, Yokote Y, Omoto R, sponsored by Buckley MJ: Intraoperative color flow mapping by real-time two-dimensional Doppler echocardiography for evaluation of the valvular and the congenital heart disease, and the vascular disease (Abstract). Program of Annual Meeting of 65th Am Assoc Thorac Surg: 32, 1985.Google Scholar
- 10.Grossman W: Complication of cardiac catheterization. Indication, causes and prevention. In: Grossman R (ed.) Cardiac catheterization and angiography, pp. 25 - 35. Philadelphia: Lea & Febiger, 1974.Google Scholar
- 11.Brandestini MA, Howard EA, Weile EB, Stevenson JG, Eyer MK: The synthesis of echo and Doppler in M-mode and sector scan. Proceedings of AIUM paper, No. 704: 125, 1979.Google Scholar
- 12.Kitabatake K, Inoue M, Asano M, Mishima M, Tanouchi J, Masuyama T, Hori M, Abe H, Chihara K, Sakurai H, Senda S, Morita H, Matsuo H: Non-invasive visualization of intracardiac blood flow in human heart using computer-aided pulsed Doppler technique. Clinical Hemorheology 1: 85–91, 1982.Google Scholar
- 14.Namekawa K, Kasai C, Tsukamoto M, Koyano A: Imaging of blood flow using autocorrelation. Ultrasound in Medicine & Biology 8: 138, 1982.Google Scholar
- 16.Ishida T, Kyo S, Motoyama T: Observation of the intracardiac blood flow in fetus by color flow mapping Doppler echocardiography. Proceedings of JSUM 45: 305–306, 1984.Google Scholar
- 18.Glenn WWL, Baue AE, Geha AS, Hammond GL, Laks H: Thoracic and cardiovascular surgery, pp. 732–44. Norwalk, CT: Appleton-Century-Crofts, 1975.Google Scholar
- 19.Nadas AS, Tyler DC: Pediatric cardiology, pp. 405–26. Philadelphia: Saunders, 1972.Google Scholar
- 20.Glenn WWL, Baue AE, Geha AS, Hammond GL, Laks H: Thoracic and cardiovascular surgery, pp. 745–56. Norwalk, CT: Appleton-Century-Crofts, 1975.Google Scholar
- 21.Kyo S, Omoto R, Takamoto S, Yokote Y: Noninvasive analysis of bi-directional multi-phasic intracardiac shunts by real-time two-dimensional Doppler Echocardiography. Circulation 70 (Suppl II): 11–365, 1984.Google Scholar