Sreeram N, Colli A M, Monro J L, Shore D F, Lamb R K, Fong L V, Smyllie J H, Keeton B R, Sutherland G R
Wessex Regional Cardiothoracic Centre, Southampton General Hospital.
Br Heart J. 1990 Jun;63(6):345-9. doi: 10.1136/hrt.63.6.345.
The total surgical experience of a supraregional paediatric cardiology unit over a nine year period (January 1980 to December 1988) was reviewed to assess the effect of the introduction of the full range of ultrasound techniques. A total of 1517 patients underwent cardiac surgery (955 cardiopulmonary bypass, 562 closed procedures). Of these, 485 patients (32%) did not undergo cardiac catheterisation before operation: 217 bypass (23% of all procedures under cardiopulmonary bypass) and 268 closed procedures (48%). The overall ratio of catheterisations to operations for patients undergoing palliative or corrective surgery fell from 0.97 (1980) to 0.38 (1988). The patients were classified as (a) neonates (0-28 days), (b) infants (one to 12 months), and (c) children (one to 14 years). The main impact of non-invasive surgical referral was in neonates (total catheter:operation ratio 0.38; neonates 0.2 for 1988). The surgical population was further divided according to the principal echocardiographic technique available: (a) 1980-4 cross sectional imaging; (b) 1985-6; imaging plus spectral Doppler ultrasound; (c) 1987-8; imaging plus spectral Doppler ultrasound and colour flow mapping. A fall in the catheter:operation ratio for all age groups was most pronounced in the last four years. This reflects increased familiarity and surgical confidence with non-invasive diagnostic assessment. The introduction of each new echocardiographic technique was associated with a significant fall in the total catheter:operation ratio compared with the preceding period. Six incorrect ultrasound diagnoses were made during the entire period; one of these patients died in the early postoperative period. The integration of Doppler ultrasound with cross sectional imaging has made non-invasive assessment an increasingly practical alternative to preoperative cardiac catheterization.
回顾了一个区域儿科心脏病治疗单位在九年期间（1980年1月至1988年12月）的全部手术经验，以评估引入全套超声技术的效果。共有1517例患者接受了心脏手术（955例体外循环手术，562例闭式手术）。其中，485例患者（32%）术前未进行心导管检查：217例体外循环手术（占所有体外循环手术的23%）和268例闭式手术（占48%）。接受姑息性或矫正性手术患者的心导管检查与手术的总体比例从1980年的0.97降至1988年的0.38。患者分为（a）新生儿（0 - 28天）、（b）婴儿（1至12个月）和（c）儿童（1至14岁）。非侵入性手术转诊的主要影响在新生儿中最为明显（心导管检查与手术的总体比例为0.38；1988年新生儿为0.2）。手术人群根据可用的主要超声心动图技术进一步划分：（a）1980 - 4年为横断面成像；（b）1985 - 6年为成像加频谱多普勒超声；（c）1987 - 8年为成像加频谱多普勒超声和彩色血流图。在过去四年中，所有年龄组的心导管检查与手术比例下降最为明显。这反映出对非侵入性诊断评估的熟悉程度增加以及手术信心增强。与前一时期相比，每种新的超声心动图技术的引入都伴随着心导管检查与手术的总体比例显著下降。在整个期间共做出6例超声诊断错误；其中1例患者在术后早期死亡。多普勒超声与横断面成像的结合使非侵入性评估越来越成为术前心导管检查的实用替代方法。
