Li Xiaokui, Mack Gordon K, Rusk Rosemary A, Dai Xiao-Nan, El-Sedfy Ghada O M, Davies Crispin H, Sahn David J
Clinical Care Center for Congenital Heart Disease, Oregon Health and Science University, Portland, USA.
J Am Soc Echocardiogr. 2003 Oct;16(10):1007-14. doi: 10.1016/S0894-7317(03)00489-9.
There is significant interest in opportunities to provide echocardiography services for detection of congenital heart disease with portable, or even handheld, devices in remote areas or third world countries where conventional ultrasound systems may not be available. We tested a handheld system (HHS) (SonoHeart, SonoSite Inc, Bothell, Wash) equipped with a broadband, 7- to 4-MHz, miniaturized, curved, linear-array transducer and implemented with an improved directional Doppler flow map.
All echocardiography scanning was performed in the neonatal nursery, pediatric intensive care department, or pediatric echocardiography laboratory of our institution. We reviewed limited echocardiography view sequences sequentially obtained by the same expert examiner (D.J.S.) in 50 infants and children (age: 1 day to 6 years), with preoperative or postoperative forms of congenital heart disease. Each patient was studied twice, once with a conventional full-feature system (FFS) and then a limited scan with the HHS using similar frequency transducers. The cardiologist (D.J.S.) and blinded research laboratory reviewers (X.L., G.K.M., R.A.R.) read the FFS and HHS image sequences for diagnosis and for grading the quality of the anatomic and flow feature images. The studies were performed and reviewed with the examiner and reviewers blinded to patient diagnosis.
The major diagnoses (eg, patent ductus arteriosus, atrio-ventricular (AV) canal, peripheral pulmonary valve stenosis, aortic coarctation, atrial septal defect, ventricular septal defect, preoperative or postoperative tetralogy of Fallot, and mitral regurgitation) were made by both readers, who were unaware of each other's diagnosis results. Furthermore, the average composite HHS cardiac anatomic feature score on a scale of 0 (not visualized) to 3 (visualized precisely) from the parasternal long-axis and 4- or 5-chamber view for cardiac anatomy were 2.67 +/- 0.49 (SD) and 2.50 +/- 0.55, respectively, versus 2.73 +/- 0.45 and 2.55 +/- 0.54 for the FFS. The mean flow feature score, comprising all views, was 2.67 +/- 0.45 (HHS) versus 2.72 +/- 0.48 (FFS). The P values for all above comparisons were >.05. Image quality of the FFS anatomic structures were, thus, not statistically different from the HHS. Although the color cosmetic was different for the HHS directional (nonvelocity) map, only 9% of 150 total findings (including structural abnormalities and flow features, none of which were critical) were missed, whereas the other 91% regurgitant, shunt, stenosis flow features or heart structure were imaged adequately by the HHS in this population.
Implementing high-frequency transducers and programs optimized for tissue and flow imaging on the HHS should provide images of sufficient quality for targeted echocardiography examinations to determine the presence, absence, or status of congenital heart disease in newborns and young children.
在偏远地区或第三世界国家，由于可能无法获得传统超声系统，因此人们对利用便携式甚至手持式设备提供超声心动图服务以检测先天性心脏病的机会有着浓厚兴趣。我们测试了一种手持式系统（HHS）（SonoHeart，SonoSite公司，华盛顿州博塞尔），该系统配备了宽带、7至4兆赫兹、小型化、弯曲的线性阵列换能器，并采用了改进的定向多普勒血流图。
所有超声心动图扫描均在我们机构的新生儿重症监护室、儿科重症监护病房或儿科超声心动图实验室进行。我们回顾了由同一位专家检查者（D.J.S.）在50例患有先天性心脏病术前或术后的婴儿和儿童（年龄：1天至6岁）中依次获得的有限超声心动图视图序列。每位患者均接受两次检查，一次使用传统的全功能系统（FFS），然后使用频率相似的换能器通过HHS进行有限扫描。心脏病专家（D.J.S.）和不知情的研究实验室评审员（X.L.、G.K.M.、R.A.R.）阅读FFS和HHS图像序列以进行诊断，并对解剖和血流特征图像的质量进行分级。研究在检查者和评审员对患者诊断不知情的情况下进行和评审。
两位读者均做出了主要诊断（例如，动脉导管未闭、房室通道、外周肺动脉瓣狭窄、主动脉缩窄、房间隔缺损、室间隔缺损、法洛四联症术前或术后以及二尖瓣反流），且彼此不知对方的诊断结果。此外，从胸骨旁长轴和心脏解剖的四腔或五腔视图来看，HHS心脏解剖特征的平均综合评分在0（未显示）至3（精确显示）的范围内，分别为2.67±0.49（标准差）和2.50±0.55，而FFS的评分为2.73±0.45和2.55±0.54。包含所有视图的平均血流特征评分为2.67±0.45（HHS），而FFS为2.72±0.48。上述所有比较的P值均>.05。因此，FFS解剖结构的图像质量与HHS在统计学上无差异。尽管HHS定向（非速度）图的颜色外观不同，但在总共150项检查结果（包括结构异常和血流特征，均无关键结果）中，只有9%被漏诊，而在该人群中，HHS对其他91%的反流、分流、狭窄血流特征或心脏结构进行了充分成像。
在HHS上采用针对组织和血流成像进行优化的高频换能器和程序，应为针对性超声心动图检查提供足够质量的图像，以确定新生儿和幼儿先天性心脏病的存在、不存在或状况。
