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Year : 2022  |  Volume : 25  |  Issue : 4  |  Page : 478-482

Pre-operative 2-D transthoracic echocardiographic diagnosis with intra-operative findings of children with structural heart diseases: A comparative analysis

1 Department of Paediatrics/Paediatric Cardiology Unit, University of Nigeria, Ituku Ozalla, Enugu, Nigeria
2 Department of Surgery/Cardio-thoracic Centre of Excellence, University of Nigeria, Ituku Ozalla, Enugu, Nigeria

Correspondence Address:
Prof. J M Chinawa
Department of Paediatrics, College of Medicine, University of Nigeria Enugu Campus, PMB 40001, Enugu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/njcp.njcp_1714_21

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Background: Structural heart disease is a major cause of morbidity and mortality in children. Echocardiography is accepted as the first line cost-effective diagnostic modality for pre-operative assessment of children with structural heart diseases. Two-dimensional transthoracic echocardiography (2-D TTE) may be the only diagnostic tool in a resource-poor environment where further investigations may be very expensive and not readily available. Aim: The aim of the study is to determine the degree of accuracy of pre-operative 2-D echocardiographic diagnosis with eventual surgical (intra-operative) findings among children with structural heart diseases with a view to audit the echocardiographic diagnoses and final surgical diagnoses among the patients in the University of Nigeria Teaching Hospital Ituku-Ozalla Enugu, a tertiary cardiothoracic center in Enugu, South-east Nigeria. Patients and Methods: 2-D TEE (GE Model) diagnosis of all the children that had cardiac surgery at University of Nigeria Teaching Hospital (UNTH) Ituku/Ozalla Enugu over a 3-year period was studied. All the patients had at least two echocardiographic sessions and results were recorded in a proforma. Surgical findings were obtained from post-operative surgical notes. Intra-operative findings were compared with 2-D TTE findings. Data were analyzed using SPSS version 20. The degree of accuracy was expressed as percentages. The relationship between the sensitivity of 2-D TTE and intra-operative findings as ascertained using sensitivities and positive predictive values. Results: There were 55 pediatric cardiac operations performed within the period under review. There were 22 males and 23 females, the age range was from 8 months to 17 years. Fifty-two (94.5%) were due to congenital heart diseases, whereas three (5.5%) were due to acquired heart diseases. Echocardiographic findings were the same as surgical findings in all isolated PDAs (100%), Isolated ASDs (100%), Mitral valve regurgitation three (100%), but missed out PDA as an associated finding in a case of sub-aortic VSD (7.7%) and an ASD in a case of TOF (5.9%), congenital absence of tricuspid valve was also missed as a component of complex cardiac anomaly one (1.1%). These omissions however did not change the surgical approach and outcome. Pre-operative echocardiographic diagnoses and eventual surgical diagnoses were largely concordant. The sensitivity of 2-D TTE and intra-operative findings is 94.5%, positive predictive value is 94.5%, and the false negative rate is 5.5%. Conclusion: Echocardiography is a veritable diagnostic tool in the pre-operative evaluation of children with structural heart diseases. Continuous training and re-training are key in skill development and capacity building in resource-poor countries.

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