Carmo Mendes Inês, Heard Hannah, Peacock Kelly, Krasemann Thomas, Morgan Gareth J
Department of Pediatric Cardiology, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK.
Department of Pediatric Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
Pediatr Cardiol. 2017 Feb;38(2):302-307. doi: 10.1007/s00246-016-1513-5. Epub 2017 Jan 11.
Device selection and procedural guidance for percutaneous ductal closure strongly rely upon angiographic and echocardiographic imaging. Current literature recognises 2D echocardiography as an essential tool for diagnosis and assessment but does not define a consistent methodology to optimise ductal measurement. There is little research comparing echocardiography with gold standard angiography for ductal measurement. Proving 2D echocardiographic ductal measurement to be equivalent to angiography could pave the way for its use as the primary modality in image guidance for percutaneous closure of the ductus. This was a retrospective study of 100 consecutive paediatric patients who underwent percutaneous ductal closure. Echocardiographic images were studied to determine ductal (a) morphology (b) dimensions (length, aortic ampulla, pulmonary end, minimum diameter) (c) size of device that would be appropriate for closure. These data were compared to corresponding measurements generated by angiographic images. Inter and intra-observer ratings were calculated to assess levels of agreement. There were significant differences between the imaging methods in classifying the morphological sub-type and ductal measurements (p < 0.005), except for length which was not found to be significantly different between modalities. Prediction of device selection from angiographic images showed excellent agreement (weighted k = 0.81). Predictions based on echocardiographic images showed a poor level of agreement (weighted k = 0.14). We found poor correlation between echocardiography and angiography for measurement, morphological assessment and device selection. Based on our findings, percutaneous arterial duct occlusion without angiographic guidance in this age group cannot be advocated.
经皮导管封堵术的设备选择和操作指导严重依赖血管造影和超声心动图成像。当前文献将二维超声心动图视为诊断和评估的重要工具，但未定义优化导管测量的一致方法。很少有研究将超声心动图与用于导管测量的金标准血管造影进行比较。证明二维超声心动图导管测量等同于血管造影可为其用作经皮导管封堵术图像引导的主要方式铺平道路。这是一项对100例连续接受经皮导管封堵术的儿科患者的回顾性研究。研究超声心动图图像以确定导管的（a）形态（b）尺寸（长度、主动脉壶腹、肺动脉端、最小直径）（c）适合封堵的设备尺寸。将这些数据与血管造影图像生成的相应测量值进行比较。计算观察者间和观察者内评分以评估一致性水平。除长度在不同方式之间未发现有显著差异外，成像方法在形态学亚型分类和导管测量方面存在显著差异（p < 0.005）。从血管造影图像预测设备选择显示出极好的一致性（加权k = 0.81）。基于超声心动图图像的预测显示一致性水平较差（加权k = 0.14）。我们发现超声心动图与血管造影在测量、形态学评估和设备选择方面的相关性较差。基于我们的研究结果，不能提倡在该年龄组中在没有血管造影引导的情况下进行经皮动脉导管封堵。
