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CLINICAL STUDY: CONGENITAL HEART DISEASE

Echocardiographic predictors of aortopulmonary collaterals in infants with tetralogy of fallot and pulmonary atresia

Andrew S. Mackie, MD^*,, Kimberlee Gauvreau, ScD^*,, Stanton B. Perry, MD^*,, Pedro J. del Nido, MD, PhD^, and Tal Geva, MD, FACC^*,,*

^* Departments of Cardiology, Children’s Hospital, Boston, Massachusetts, USA
Cardiac Surgery, Children’s Hospital, Boston, Massachusetts, USA
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA

Manuscript received May 29, 2002; revised manuscript received October 10, 2002, accepted October 31, 2002.

^* Reprint requests and correspondence: Dr. Tal Geva, Department of Cardiology, Children’s Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115, USA.
tal.geva{at}tch.harvard.edu

OBJECTIVES: This study was designed to identify echocardiographic predictors of aortopulmonary collaterals (APCs) in infants with tetralogy of Fallot and pulmonary atresia (TOF/PA) and to prospectively validate these predictors.

BACKGROUND: In patients with TOF/PA, routine preoperative diagnostic cardiac catheterization is usually performed to determine the presence and distribution of APCs and the anatomy of the branch pulmonary arteries.

METHODS: The clinical and diagnostic imaging data of infants with TOF/PA treated between 1990 and 2000 were reviewed. Patients were classified into two groups based on cineangiographic findings: 1) no APCs (n = 34), and 2) 1 APCs (n = 59). Echocardiographic variables were examined for their ability to identify patients having 1 APCs.

RESULTS: Median branch pulmonary artery diameter Z scores were significantly larger in patients without APCs compared with those having 1 APCs: –0.56 versus –3.24 for the left pulmonary artery and –0.76 versus –3.46 for the right pulmonary artery (p < 0.001). The presence of a branch pulmonary artery diameter Z score –2.5 was 88% sensitive and 100% specific for the presence of 1 APCs. Detection of APCs by color Doppler was 93% sensitive and 91% specific. A combination of branch pulmonary artery diameter Z score –2.5 or patent ductus arteriosus diameter 2 mm was 97% sensitive and 100% specific for the presence of 1 APCs. The diagnostic accuracy of these echocardiographic variables was subsequently validated in a prospective study of 11 infants.

CONCLUSIONS: Echocardiography is a sensitive and specific test for the detection of 1 APCs in infants with TOF/PA. These data can be used to select patients who can undergo complete repair of TOF/PA without further preoperative diagnostic imaging.

Abbreviations and Acronyms   APCs   aortopulmonary collaterals   BSA   body surface area   LPA   left pulmonary artery   PDA   patent ductus arteriosus   ROC   receiver-operator characteristic   RPA   right pulmonary artery   TOF/PA   tetralogy of Fallot and pulmonary atresia