Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark.
Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Cardiol Young. 2023 Oct;33(10):1942-1949. doi: 10.1017/S1047951122003365. Epub 2022 Nov 21.
An interatrial communication is present in most neonates. The majority are considered the "normal" patency of the oval foramen, while a minority are abnormal atrial septal defects. Differentiation between the two with transthoracic echocardiography may be challenging, and no generally accepted method of classification is presently available. We aimed to develop and determine the reliability of a new classification of interatrial communications in newborns.
An algorithm was developed based on echocardiographic criteria from 495 newborns (median age 11[8;13] days, 51.5% females). The algorithm defines three main categories: patency of the oval foramen, atrial septal defect, and no interatrial communication as well as several subtypes. We found an interatrial communication in 414 (83.6%) newborns. Of these, 386 (93.2%) were categorised as patency of the oval foramen and 28 (6.8%) as atrial septal defects.Echocardiograms from another 50 newborns (median age 11[8;13] days, 36.0% female), reviewed by eight experts in paediatric echocardiography, were used to assess the inter- and intraobserver variation of classification of interatrial communications into patency of the oval foramen and atrial septal defect, with and without the use of the algorithm. Review with the algorithm gave a substantial interobserver agreement (kappa = 0.66), and an almost perfect intraobserver agreement (kappa = 0.82). Without the use of the algorithm, the interobserver agreement between experienced paediatric cardiologists was low (kappa = 0.20).
A new algorithm for echocardiographic classification of interatrial communications in newborns produced almost perfect intraobserver and substantial interobserver agreement. The algorithm may prove useful in both research and clinical practice.
房间隔沟通在大多数新生儿中存在。大多数被认为是卵圆孔的“正常”开放，而少数是异常的房间隔缺损。经胸超声心动图可能难以区分两者，目前尚无普遍接受的分类方法。我们旨在开发并确定一种新的新生儿房间隔沟通分类方法的可靠性。
根据 495 名新生儿（中位年龄 11[8；13]天，51.5%为女性）的超声心动图标准制定了一种算法。该算法定义了三个主要类别：卵圆孔开放、房间隔缺损和无房间隔沟通，以及几个亚型。我们在 414 名（83.6%）新生儿中发现了房间隔沟通。其中 386 名（93.2%）被归类为卵圆孔开放，28 名（6.8%）为房间隔缺损。
我们还使用来自另外 50 名新生儿（中位年龄 11[8；13]天，36.0%为女性）的超声心动图，由 8 名儿科超声心动图专家进行复查，以评估不使用和使用算法对卵圆孔开放和房间隔缺损分类的分类的观察者间和观察者内差异。使用算法进行复查可获得良好的观察者间一致性（kappa = 0.66）和几乎完美的观察者内一致性（kappa = 0.82）。不使用算法时，经验丰富的儿科心脏病专家之间的观察者间一致性较低（kappa = 0.20）。
一种新的用于新生儿房间隔沟通的超声心动图分类算法产生了几乎完美的观察者内和良好的观察者间一致性。该算法在研究和临床实践中可能都很有用。
