Is routine preoperative 2-dimensional echocardiography necessary for infants with esophageal atresia, omphalocele, or anorectal malformations?

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• 作者：Ahmed Nasr ; Patrick J. McNamara ; Luc Mertens ; David Levin ; Andrew James ; Helen Holtby ; Jacob C. Langer
• 关键词：Esophageal atresia ; Anorectal malformation ; Omphalocele ; Echocardiography ; Imperforate anus ; Tracheoesophageal fistula ; Abdominal wall defect
• 刊名：Journal of Pediatric Surgery
• 出版年：2010
• 出版时间：May 2010
• 年：2010
• 卷：45
• 期：5
• 页码：876-879
• 全文大小：94 K

文摘

Background

Infants with esophageal atresia (EA), omphalocele, and anorectal malformation (ARM) often have associated congenital heart disease. Recognition of significant cardiac defects, which compromise patient well-being in the perioperative period, is essential before going to the operating room. However, urgent echocardiography may be unavailable, and surgery may therefore be delayed in some cases. We wished to determine if routine echocardiography is necessary for neonates with these diagnoses, or if appropriate patients could be selected.

Methods

Retrospective review of all infants admitted to the neonatal intensive care unit with EA, omphalocele, or ARM for 5 years (2003-2008). Clinically relevant findings in the cardiovascular examination (murmur, tachycardia, abnormal 4 limb blood pressure, cyanosis, shock), abnormalities in respiratory examination (intubation, tachypnea, desaturations), or abnormal chest x-ray (cardiomegaly, abnormal pulmonary vasculature) were documented. Cardiac defects were categorized according to their clinical impact as major or minor to differentiate those disorders which may influence timing of surgical intervention.

Results

Eighty-six infants were identified (33 EA, 21 omphalocele, 32 ARM). Thirty-seven (42.9 % ) patients had congenital heart disease on echocardiography evaluation, of which 11 (12.7 % ) were classified as major and 26 (30.2 % ) were minor. The sensitivity, specificity, positive predictive value, and negative predictive value of abnormal clinical and radiologic combined assessment for a major cardiac defect were 100 % (95 % confidence interval [CI], 0.76-1), 64 % (95 % CI, 0.61-0.64), 28 % (95 % CI, 0.22-0.29), and 100 % (95 % CI, 0.94-1.00), respectively.

Conclusions

Normal clinical and radiologic examination predicted absence of a significant cardiac abnormality on echocardiography in 100 % of cases. We conclude that routine echocardiography before embarking on surgical intervention may not always be necessary but should be reserved for infants with abnormal clinical and/or radiologic findings.