Pediatric open heart operations without diagnostic cardiac catheterization

Background. Echocardiography allows for an adequate noninvasive preoperative evaluation in an increasing proportion of pediatric patients before open heart operations. The present study assessed the diagnostic accuracy of both invasive and noninvasive preoperative evaluation in children with congenital heart disease. Methods. We prospectively evaluated the accuracy of preoperative noninvasive or invasive diagnostic methods. Preoperatively established diagnosis was compared with the intraoperative diagnosis made by surgical inspection and routine perioperative transesophageal echocardiography. Results. During the study period of 30 months (ending in December 1997) 209 open-heart procedures were performed. Eighty-one patients (39%) were in the first year of life at the time of surgery, and 43% of all patients had symptoms. Noninvasive preoperative diagnosis using echocardiography was done exclusively in 142 patients (68%). Of the 67 children who had preoperative catheterization, 4 (6%) showed an additional intraoperative finding that modified the surgical approach in 2 of them. In the 142 patients who had echocardiographic preoperative assessment, the surgeons were confronted with a previously undiagnosed finding in 12 patients (8.5%). The finding was considered significant (prolongation of cardiopulmonary bypass time) in 2 patients and might have affected the outcome in 1 of them, a neonate with transposition of the great arteries and a preoperatively undiagnosed intramural coronary artery, who died postoperatively despite a technically adequate repair. Conclusions. In many infants and children, diagnostic work-up before open heart operations could be adequately based on an exclusively noninvasive basis by relying on echocardiography alone.