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Efficacy of bubble contrast echocardiography in detecting pulmonary arteriovenous fistulas in children with univentricular heart after total cavopulmonary connection

Published online by Cambridge University Press:  09 January 2020

Dai Asada Open the ORCID record for Dai Asada [Opens in a new window] ,
Yuma Morishita ,
Yoko Kawai ,
Yo Kajiyama  and
Kazuyuki Ikeda
Dai Asada*
Affiliation:
Department of Pediatric Cardiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
Yuma Morishita
Affiliation:
Department of Pediatric Cardiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
Yoko Kawai
Affiliation:
Department of Pediatric Cardiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
Yo Kajiyama
Affiliation:
Department of Pediatric Cardiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
Kazuyuki Ikeda
Affiliation:
Department of Pediatric Cardiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
*
Author for correspondence: D. Asada, Department of Pediatric Cardiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto602-8566, Japan. Tel: +81 75 251 5832; Fax: +81 75 251 5833; E-mail: asadadai@koto.kpu-m.ac.jp
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Abstract

Background:

Development of pulmonary arteriovenous fistulas in patients with cavopulmonary anastomosis may result in a significant morbidity. Although the use of bubble contrast echocardiography with selective injection into both the branch pulmonary arteries in identifying pulmonary arteriovenous fistulas has been increasing, the actual efficacy of this diagnostic modality has not been properly evaluated. Thus, this study aimed to assess the efficacy of bubble contrast echocardiography in detecting pulmonary arteriovenous fistulas in children with total cavopulmonary connection.

Methods:

A total of 140 patients were included. All patients underwent cardiac catheterisation. Bubble contrast echocardiographic studies were performed by injecting agitated saline solution into the branch pulmonary arteries. Transthoracic echocardiograms that use an apical view were conducted to assess the appearance of bubble contrast in the systemic ventricles. Then, the contrast echocardiogram results and other cardiac parameters were compared.

Results:

No correlation was found between contrast echocardiogram grade and other cardiac parameters, such as pulmonary capillary wedge saturation and pulmonary artery resistance. Moreover, only 13 patients had negative results on both the right and left contrast echocardiograms, and 127 of the 140 patients had positive results on contrast echocardiograms even though they had normal pulmonary capillary wedge saturation. Results showed that bubble contrast echocardiography was a highly sensitive method and was likely to obtain false-positive results.

Conclusions:

Bubble contrast echocardiography might be highly false positive in detecting pulmonary arteriovenous fistulas in patients with cavopulmonary anastomosis. We have to consider how we make use of this method. Further standardisation of techniques is required.

Keywords

Pulmonary arteriovenous fistulasbubble contrast echocardiographytotal cavopulmonary connection
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 2 , February 2020 , pp. 227 - 230
Copyright
© Cambridge University Press 2020

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