Freed M D, Nadas A S, Norwood W I, Castaneda A R
J Am Coll Cardiol. 1984 Aug;4(2):333-6. doi: 10.1016/s0735-1097(84)80222-3.
Between January 1976 and July 1983, 217 patients with atrial septal defect underwent surgical repair at Children's Hospital. Thirty with a primum atrial septal defect and 26 who underwent cardiac catheterization elsewhere before being seen were excluded from analysis. Of the 161 remaining patients, 52 (31%) underwent preoperative cardiac catheterization, 38 because the physical examination was considered atypical for a secundum atrial septal defect and 14 because of a preexisting routine indication. One hundred nine (69%) underwent surgery without catheterization, with the attending cardiologist relying on clinical examination alone in 5, additional technetium radionuclide angiocardiography in 5, M-mode echocardiography in 13 and two-dimensional echocardiography in 43; both M-mode echocardiography and radionuclide angiography were performed in 24 and two-dimensional echocardiography and radionuclide angiography in 19. Since 1976, there has been a trend toward a reduction in the use of catheterization and use of one rather than two noninvasive or semiinvasive techniques for the detection of atrial defects. Of the 52 patients who underwent catheterization, the correct anatomic diagnosis was made before catheterization in 47 (90%). Two patients with a sinus venosus defect and one each with a sinus venosus defect plus partial anomalous pulmonary venous connection, partial anomalous pulmonary venous connection without an atrial septal defect and a sinoseptal defect were missed. Of 109 patients without catheterization, a correct morphologic diagnosis was made before surgery in 92 (84%). Nine patients with a sinus venosus defect, three with sinus venous defect and partial anomolous pulmonary venous connection, four with partial anomalous pulmonary venous return without an atrial septal defect and one with a secundum defect were incorrectly diagnosed.(ABSTRACT TRUNCATED AT 250 WORDS)
1976年1月至1983年7月期间，217例房间隔缺损患者在儿童医院接受了手术修复。30例原发孔型房间隔缺损患者以及26例在来本院就诊前曾在其他地方接受心导管检查的患者被排除在分析之外。在其余161例患者中，52例（31%）接受了术前心导管检查，38例是因为体格检查被认为不符合继发孔型房间隔缺损的典型表现，14例是因为存在常规检查指征。109例（69%）患者未进行心导管检查即接受了手术，其中5例仅依靠主治心脏病专家的临床检查，5例额外进行了锝放射性核素血管造影，13例进行了M型超声心动图检查，43例进行了二维超声心动图检查；24例同时进行了M型超声心动图检查和放射性核素血管造影，19例同时进行了二维超声心动图检查和放射性核素血管造影。自1976年以来，出现了减少使用心导管检查以及使用一种而非两种非侵入性或半侵入性技术来检测房间隔缺损的趋势。在52例接受心导管检查的患者中，47例（90%）在心导管检查前做出了正确的解剖学诊断。2例静脉窦型缺损患者、1例静脉窦型缺损合并部分肺静脉异位连接患者、1例无房间隔缺损的部分肺静脉异位连接患者以及1例窦房隔缺损患者被漏诊。在109例未进行心导管检查的患者中，92例（84%）在手术前做出了正确的形态学诊断。9例静脉窦型缺损患者、3例静脉窦型缺损合并部分肺静脉异位连接患者、4例无房间隔缺损的部分肺静脉异位回流患者以及1例继发孔型缺损患者被误诊。（摘要截短至250字）
