Department of Paediatrics/Paediatric Cardiology Unit, University of Nigeria, Ituku Ozalla, Enugu, Nigeria.
Department of Surgery/Cardio-thoracic Centre of Excellence, University of Nigeria, Ituku Ozalla, Enugu, Nigeria.
Niger J Clin Pract. 2022 Apr;25(4):478-482. doi: 10.4103/njcp.njcp_1714_21.
Structural heart disease is a major cause of morbidity and mortality in children. Echocardiography is accepted as the first line cost-effective diagnostic modality for pre-operative assessment of children with structural heart diseases. Two-dimensional transthoracic echocardiography (2-D TTE) may be the only diagnostic tool in a resource-poor environment where further investigations may be very expensive and not readily available.
The aim of the study is to determine the degree of accuracy of pre-operative 2-D echocardiographic diagnosis with eventual surgical (intra-operative) findings among children with structural heart diseases with a view to audit the echocardiographic diagnoses and final surgical diagnoses among the patients in the University of Nigeria Teaching Hospital Ituku-Ozalla Enugu, a tertiary cardiothoracic center in Enugu, South-east Nigeria.
2-D TEE (GE Model) diagnosis of all the children that had cardiac surgery at University of Nigeria Teaching Hospital (UNTH) Ituku/Ozalla Enugu over a 3-year period was studied. All the patients had at least two echocardiographic sessions and results were recorded in a proforma. Surgical findings were obtained from post-operative surgical notes. Intra-operative findings were compared with 2-D TTE findings. Data were analyzed using SPSS version 20. The degree of accuracy was expressed as percentages. The relationship between the sensitivity of 2-D TTE and intra-operative findings as ascertained using sensitivities and positive predictive values.
There were 55 pediatric cardiac operations performed within the period under review. There were 22 males and 23 females, the age range was from 8 months to 17 years. Fifty-two (94.5%) were due to congenital heart diseases, whereas three (5.5%) were due to acquired heart diseases. Echocardiographic findings were the same as surgical findings in all isolated PDAs (100%), Isolated ASDs (100%), Mitral valve regurgitation three (100%), but missed out PDA as an associated finding in a case of sub-aortic VSD (7.7%) and an ASD in a case of TOF (5.9%), congenital absence of tricuspid valve was also missed as a component of complex cardiac anomaly one (1.1%). These omissions however did not change the surgical approach and outcome. Pre-operative echocardiographic diagnoses and eventual surgical diagnoses were largely concordant. The sensitivity of 2-D TTE and intra-operative findings is 94.5%, positive predictive value is 94.5%, and the false negative rate is 5.5%.
Echocardiography is a veritable diagnostic tool in the pre-operative evaluation of children with structural heart diseases. Continuous training and re-training are key in skill development and capacity building in resource-poor countries.
结构性心脏病是儿童发病和死亡的主要原因。超声心动图被认为是结构性心脏病患儿术前评估的一种具有成本效益的一线诊断方法。在资源匮乏的环境中，二维经胸超声心动图（2-D TTE）可能是唯一的诊断工具，因为进一步的检查可能非常昂贵且难以获得。
本研究旨在确定术前 2-D 超声心动图诊断与结构性心脏病患儿最终手术（术中）发现之间的准确度，以期审核尼日利亚大学教学医院伊图库-奥扎拉恩古（UNTH）的超声心动图诊断和最终手术诊断，该医院是尼日利亚东南部埃努古的一家三级心胸中心。
研究了在尼日利亚大学教学医院（UNTH）伊图库/奥扎拉恩古进行心脏手术的所有儿童的 2-D TEE（GE 型号）诊断。所有患者至少进行了两次超声心动图检查，并将结果记录在表格中。手术结果从术后手术记录中获得。术中发现与 2-D TTE 发现进行比较。使用 SPSS 版本 20 分析数据。准确度以百分比表示。使用敏感性和阳性预测值确定 2-D TTE 的敏感性与术中发现之间的关系。
在审查期间共进行了 55 例儿科心脏手术。有 22 名男性和 23 名女性，年龄范围为 8 个月至 17 岁。52 例（94.5%）是由先天性心脏病引起的，而 3 例（5.5%）是由获得性心脏病引起的。在所有孤立的 PDAs（100%）、孤立的 ASD（100%）、二尖瓣反流中，超声心动图发现与手术发现完全一致，但在一个亚主动脉 VSD（7.7%）和一个 TOF（5.9%）病例中，漏诊了 PDA 作为一种关联发现，先天性三尖瓣缺失也作为一种复杂心脏畸形的组成部分漏诊了一例（1.1%）。这些遗漏并没有改变手术方法和结果。术前超声心动图诊断和最终手术诊断基本一致。2-D TTE 和术中发现的灵敏度为 94.5%，阳性预测值为 94.5%，假阴性率为 5.5%。
超声心动图是结构性心脏病患儿术前评估的一种可靠诊断工具。在资源匮乏的国家，持续的培训和再培训是技能发展和能力建设的关键。
