Does 2D Echocardiography Tally With Clinical Diagnosis In The Management Of Congenital Heart Disease?

摘要

Background: The objective of this study was to determine if clinical diagnosis of cardiac abnormalities tally with 2 D Echocardiography findings.Methods: A cross-sectional retrospective study in which a review of the records of all children attending children outpatient clinics including cardiology clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu over a five year period (January 2007-June 2012) was undertaken.All children presenting with cardiac anomalies were included in the study and the cases were investigated using 2 D Echocardiographic studies.Results: A total of 31,795 children attended the children outpatient clinics of the hospital over the study period. Of these, seventy one (71) had cardiac diseases. Among children with cardiac disease ,thirty five Percent ( 35%) of all the patients had their clinical diagnosis not tallying with 2 D Echocardiography while 21 (29.5%) had clinical diagnosis in tandem with 2 D Echocardiography. Thirty five and half percent had no 2 D Echocardiograph done for them for financial reasons.Conclusions: Despite the fact that clinical diagnosis may not always tally with 2 D Echocardiography in the diagnosis of congenital heart disease ,it should not be downplayed. INTRODUCTION Cardiac disease is the leading cause of morbidity and mortality in the United States for the past 80 years. [1] This is may not be the same in developing countries, where malaria and malnutrition are major culprits. [2] Notwithstanding, mortality and morbidity from cardiac disease among children in developing countries is gaining recognizance. Heart disease also results in substantial health-care expenditures; for example, coronary heart disease is projected to cost an estimated $151.6 billion in 2007. [3]Among heart diseases in children, congenital heart defects are the most common congenital malformation, affecting 8 in every 1000 live births, and accounting for >20% of perinatal deaths.[4] Congenital heart defects (CHDs) are 6.5 times more common than chromosomal abnormalities and 4 times more common than neural tube defects.[5]The necessity of accurate clinical diagnosis of congenital heart disease without necessarily relying on sophisticated equipments such as 3D Echocardiography cannot be overemphasize especially in resource poor country like ours. However more often than not some complex cardiac lesions are missed during routine clinical examination, this has led to the development and refinement of a series of techniques and diagnostic procedures such as 2D Echocardiography and angiocardiography.[6] Although these procedures are of great diagnostic value in the recognition of the cardiac malformation, they should also serve in the promotion of a better understanding of the clinical manifestations of such malformation .[6 ] Two-Dimensional echocardiography (2-D Echo) is well accepted for evaluation of cardiac function.[7] It is the most employed cardiovascular imaging modality for assessment of cardiovascular disease and is often performed in patients without history of coronary artery disease (CAD). It is well established that several echocardiograpahic measurements provide powerful prognostic information for cardiovascular outcomes such as presence of left ventricular hypertrophy, aortic sclerosis and LVEF. [7,8]It is important to demonstrate an objective evidence of structural or functional abnormalities to explain patient's symptoms of heart anomaly since symptoms of such anomalies may be specific. It is noted that more than a third of patients with a clinical diagnosis of heart failure may not actually have heart failure. It is also interesting to note from the SHAPE study that only 3% of more than 7000 subjects surveyed from nine European countries recognized breathlessness, fatigue, and edema as symptoms of heart failure.[9] Even as at that, when someone presents with typical symptoms of heart failure, a diagnostic test, most frequently an echocardiography examination, is required to esta