Contrast Echocardiography in the Neonate

Abstract

One of the major problems of neonatal medicine is the differentiation of complex congenital heart disease from severe lung disease. The neonatologist faces three potential diagnostic groups; 1. the critically ill child with a congenital cardiac lesion who requires early catheterisation and surgical intervention; 2. the child with complex congenital heart disease who does not require emergency cardiac catheterisation or immediate surgical intervention, and 3. the child with severe respiratory or systemic disease and a structurally normal heart in whom medical supportive therapy is indicated. The signs and symptoms of respiratory disease, metabolic derangement, sepsis and other neonatal ailments may mimic exactly those of congenital heart disease and great difficulty can be encountered in reaching a correct diagnosis. If, after clinical examination, chest X-ray, 12 lead electrocardiogram, blood gas estimation in air and high oxygen concentration, the diagnosis is still uncertain, cardiac catheterisation has in the past been mandatory despite its small but important risk. Frequently, these critically ill infants are in Neonatal Units which may be distant geographically from Regional Cardiothoracic Services, and they do not travel well. Thus, a reliable method which can be taken to the infants and which can identify the cardiac cases for transfer is obviously of great value. Echocardiography has a very exciting and valuable application in this situation. It can provide anatomic information enabling the first two groups to be accurately diagnosed and with the help of chamber measurement and contrast echocardiography, it can play a significant role in all three groups in determining the cardio-respiratory pathology.