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Diagnostic Assessment of Pulmonary Atresia with Ventricular Septal Defect; Comparison of Echocardiogram with Cardiac Angiography

Journal of the Korean Pediatric Society 2001;44(2):154-160.
Published online February 15, 2001.
Diagnostic Assessment of Pulmonary Atresia with Ventricular Septal Defect; Comparison of Echocardiogram with Cardiac Angiography
Jung Yun Choi, Jeong Jin Yu, Soo Jung Kang, Jae Seong Son, Young Mee Seo, Jin Young Song, Ho Sung Kim, Eun Jung Bae, Chung Il Noh, Yong Soo Yun
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
심실 중격 결손이 있는 폐동맥 폐쇄의 진단적 평가; 심초음파와 심혈관 조영술의 비교
최정연, 유정진, 강수정, 손재성, 서영미, 송진영, 김호성, 배은정, 노정일, 윤용수
서울대학교 의과대학 소아과학교실
Abstract
Purpose
: Patients with pulmonary atresia with ventricular septal defects(PAVSD) have been a formidable surgical challenge. The source of pulmonary blood flow and vascular architecture are important in managing the surgical process. This study aimed to evaluate the usefulness of echocardiography in this process.
Methods
: This study was prospectively designed to define the role of echocardiography in PAVSD. Non-invasive evaluations including echocardiography were done, catheterization/angiography was performed the next day and the results were compared with those of echocardiography. The study population consisted of 9 patients, diagnosed as PAVSD in our hospital, from Jan. 1995 to Dec. 1997.
Results
: Pulmonary blood was supplied via ductus arteriosus, in 3 patients(group 1), and in the other 6 patients, via major aortopulmonary collateral arteries(MAPCA)(group 2). The characteristic findings of group 2 were cardiac murmur heard in the back area(3 cases), and abnormal pulmonary arborization pattern(2 cases). The echocardiographic diagnosis of source of pulmonary blood flow was correct in all cases except one case-who had had two previous shunt surgeries and additional MAPCAs. In group 2, the presence of pulmonary confluence was predicted in 3 out of 4 cases. The mean number of MAPCAs found by echocardiography was 2.3¡¾1.2 and by angiography, 3.5¡¾1.4.
Conclusion
: In evaluation of PAVSD patients, near complete characteristics of pulmonary blood supply were identified by echocardiogram. Using it, practitioners can make decisions for shunt surgery or the need for further evaluations, including cardiac catheterization which can be more easily executed with previous echocardiographic data.
Key Words: Pulmonary atresia, Major aortopulmonary collateral artery


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