Division of Pediatric Cardiology, University of Nebraska College of Medicine and Children's Hospital and Medical Center, Omaha, Nebraska.
Division of Pediatric Cardiovascular Surgery, University of Nebraska College of Medicine and Children's Hospital and Medical Center, Omaha, Nebraska.
J Am Soc Echocardiogr. 2015 Sep;28(9):1030-5. doi: 10.1016/j.echo.2015.04.009. Epub 2015 May 11.
Predischarge (pre-d/c) transthoracic echocardiography (TTE) is routine after surgery for congenital heart disease, but how it affects clinical care is unknown. The aim of this study was to test the hypothesis that pre-d/c TTE frequently reveals findings associated with short-term clinical course through a systematic review of findings on pre-d/c TTE and clinical events that followed.
Clinical outcomes of mortality, hospitalization, catheterization, and surgery at 1 year were examined for pediatric patients undergoing pre-d/c TTE between June 2010 and June 2012. Using logistic regression, a multivariate model was generated associating clinical, pre-d/c transthoracic echocardiographic, and demographic variables with unplanned postdischarge cardiac events (UCEs) within 1 year.
Of 462 patients who underwent pre-d/c TTE, there were 265 male patients (57%) and 197 female patients (43%); the median age was 0.8 years (range, 0-33 years). Two hundred thirty-seven patients (51%) had findings (valve regurgitation, hemodynamic obstruction, ventricular dysfunction, unintended shunt, or pericardial effusion) on pre-d/c TTE, 57 of which were of more than mild severity. Agreement between pre-d/c TTE and postoperative transesophageal echocardiographic findings was only fair to moderate (κ = 0.27-0.43). Sixty-four patients (14%) had UCEs. Univariate analysis revealed that UCE were more frequent in patients with diagnoses and surgical procedures of high complexity. After accounting for these confounding nonechocardiographic variables, pre-d/c transthoracic echocardiographic findings, specifically valve regurgitation of more than mild severity, and ventricular dysfunction and obstructions of any severity were independently associated with UCEs (odds ratios, 1.90, 1.99, and 1.85, respectively).
Findings on pre-d/c TTE are frequent, commonly discordant with postoperative transesophageal echocardiographic results, and associated with adverse clinical events after surgery for congenital heart disease. These data would strongly support the practice of pre-d/c TTE after surgery for congenital heart disease.
先天性心脏病手术后常规行出院前（pre-d/c）经胸超声心动图（TTE）检查，但该检查如何影响临床治疗尚不清楚。本研究旨在通过对 pre-d/c TTE 检查结果与随后临床事件的系统回顾，检验一个假设，即 pre-d/c TTE 频繁揭示与短期临床过程相关的发现。
对 2010 年 6 月至 2012 年 6 月间接受 pre-d/c TTE 的儿科患者，分析其 1 年时的死亡率、住院率、导管插入术和手术等临床结局，以及 1 年内是否发生计划外出院后心脏事件（UCE）。采用逻辑回归，建立一个将临床、pre-d/c 经胸超声心动图和人口统计学变量与 1 年内非计划性出院后心脏事件（UCE）相关联的多变量模型。
在 462 例行 pre-d/c TTE 的患者中，有 265 名男性（57%）和 197 名女性（43%），中位年龄为 0.8 岁（范围 0-33 岁）。237 例患者（51%）的 pre-d/c TTE 检查结果有异常（瓣膜反流、血流动力学梗阻、心室功能障碍、意外分流或心包积液），其中 57 例为中重度以上异常。pre-d/c TTE 与术后经食管超声心动图检查结果的一致性仅为中等至差（κ=0.27-0.43）。64 例患者（14%）发生 UCE。单变量分析显示，UCE 更常见于诊断和手术复杂程度高的患者。在排除这些非超声心动图混杂因素后，pre-d/c 经胸超声心动图的检查结果，特别是中重度以上瓣膜反流，以及任何程度的心室功能障碍和梗阻，与 UCE 独立相关（比值比分别为 1.90、1.99 和 1.85）。
pre-d/c TTE 检查结果常见，常与术后经食管超声心动图结果不一致，与先天性心脏病手术后的不良临床事件相关。这些数据将强烈支持先天性心脏病手术后行 pre-d/c TTE 的做法。
