Utility of Follow-Up Annual Echocardiograms in Patients With Complete Transposition of the Great Arteries After Arterial Switch Operations
| Autor: | Asif Padiyath, R. Thomas Collins, Shasha Bai, Jeffrey M. Gossett, Pushpa Shivaram |
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| Rok vydání: | 2018 |
| Předmět: |
Male
congenital hereditary and neonatal diseases and abnormalities medicine.medical_specialty Transposition of Great Vessels medicine.medical_treatment Physical examination 030204 cardiovascular system & hematology Asymptomatic 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans In patient Postoperative Period Complete transposition Medical expenses Retrospective Studies Cardiac catheterization medicine.diagnostic_test business.industry Infant Newborn Reproducibility of Results Arterial Switch Operation 030228 respiratory system Echocardiography Great arteries Cardiology Female Physical exam sense organs medicine.symptom Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | The American Journal of Cardiology. 122:1972-1976 |
| ISSN: | 0002-9149 |
| DOI: | 10.1016/j.amjcard.2018.08.044 |
| Popis: | The arterial switch operation (ASO) in complete transposition of the great arteries (TGA) has increased long-term survival. Annual follow-up echocardiograms are recommended, but evidence-based guidelines do not exist. We sought to assess how often a patient with TGA after ASO who had no symptoms or change in physical exam underwent an intervention based solely on echocardiographic changes. We retrospectively reviewed all records from patients with TGA and a history of ASO followed at our institution between November 1983 and January 2015. Changes in echocardiograms resulting in hospital admission, significant medication change, interventional catheterization, or surgical procedure were identified through the surgical and cardiac catheterization laboratory databases and patient charts. These changes were referred to as an actionable change (AC). Interventions were defined as being driven by either clinical (change in physical exam, patient and/or parental concerns) or echocardiographic findings. A total of 1,792 echocardiograms from 149 patients were reviewed. Median number of echocardiograms per patient was 12 (1 to 34). Of the 1,792 echocardiograms, 20 (1.12%) were associated with AC. The most common intervention for an AC was cardiac catheterization (13 of 20, 65%). Most AC (15 of 20, 75%) occurred in the first decade after ASO. AC occurred in 83% (5 of 6) of those with a history of both ASO and arch repair. Annual echocardiograms in patients with TGA after ASO are rarely useful and are unnecessary. In conclusion, decreasing surveillance of asymptomatic patients to biennial follow-up echocardiograms in asymptomatic patients without physical examination changes is safe and would decrease medical expenses. |
| Databáze: | OpenAIRE |
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