CONGENITAL HEART DISEASE

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Last Updated : 1/18/2012
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N C Joshi
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Investigations
The investigative tools that are available for

diagnosis of congenital heart diseases

include chest radiography, electrocardiography, echocardiography, cardiac catheterization, cineangiography and cardiac MRI. All tests except ECG and radiography are expensive.

Radiography of chest


It there is a suspicion of heart disease on the basis of history and physical examination, radiography which complements clinical findings should be obtained. Interpretation of chest radiograph involves evaluation of cardiac size and classical cardiac contours, lung vasculature, individual cardiac chambers, aortic arch and abdominal situs.

Electrocardiogram


Like radiography, electrocardiogram also complements clinical findings. The electrocardiogram gives valuable information about hemodynamic status of the defect and severity of the defect. A few electrocardiographic patterns are suggestive of certain lesions. Normal values of the various ECG parameters are available and for interpretation, age of the child should be kept in mind. In newborns, normal ECG and radiograph do not rule out serious cardiac defect as it takes few days to evolve.

Echocardiography
With the advent of real-time echocardiography imaging, an elegant elaboration of intracardiac anatomy of all structural defects of heart became possible. Doppler echocardiography can evaluate hemodynamic data regarding pressure difference across the aortic and pulmonary valves, detection of shunt flows, semiquantification of valve insufficiency. It has almost replaced invasive cardiac catheterization and in some centers surgical correction of lesions like PDA, ASD (ostium secundum) is possible without catheterization.

Cardiac Catheterization
The classical invasive tool pertaining to pediatric cardiology remains cardiac catheterization. As mentioned above, echocardiography has reduced diagnostic value of cardiac catheterization but interventional therapeutic catheterization procedures have increased its therapeutic value.

Indications
- Preoperative anatomical definition of the lesion
- Preoperative physiological assessment of pulmonary artery pressures, pressure gradients, etc.
- Therapeutic interventional procedure
- Balloon dilatation of stenotic valves and coarctation of aorta
- Blade and balloon atrial septostomy
- Non-surgical closure of PDA and ASD
- Catheter ablation of arrhythmogenic focus by pacemaker implantation.

References

Contributor Information and Disclosures N C Joshi
Consultant Pediatrician and Pediatric Cardiologist, Nanavati Hospital, Mumbai, India


First Created : 1/16/2001
References
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