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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: [email protected]
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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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References

Kopf, GS, Laks, H, Stansel, HC, Hellenbrand, WE, Kleinman, CS, Talner, NS.Thirty-year follow-up of superior vena cava-pulmonary artery (Glenn) shunts. J Thorac Cardiovasc Surg 1990; 100: 662–671.10.1016/S0022-5223(19)35463-7CrossRefGoogle ScholarPubMed
McFaul, RC, Tajik, AJ, Mair, DD, Danielson, GK, Seward, JB.Development of pulmonary arteriovenous shunt after superior vena cava-right pulmonary artery (Glenn) anastomosis. Report of four cases. Circulation 1977; 55: 212–216.10.1161/01.CIR.55.1.212CrossRefGoogle ScholarPubMed
Dines, DE, Seward, JB, Bernatz, PE.Pulmonary arteriovenous fistulas. Mayo Clin Proc 1983; 58: 176–181.Google ScholarPubMed
Chang, RK, Alejos, JC, Atkinson, DJ, et al.Bubble contrast echocardiography in detecting pulmonary arteriovenous shunting in children with univentricular heart after cavopulmonary anastomosis. J Am Coll Cardiol 1999; 33: 2052–2058.10.1016/S0735-1097(99)00096-0CrossRefGoogle ScholarPubMed
Feinstein, JA, Moore, P, Rosenthal, DN, Puchalski, M, Brook, MM.Comparison of contrast echocardiography versus cardiac catheterization for detection of pulmonary arteriovenous malformations. Am J Cardiol 2002; 3: 281–285.10.1016/S0002-9149(01)02228-7CrossRefGoogle Scholar
Hind, CR, Wong, CM.Detection of pulmonary arteriovenous fistulae in patient with cirrhosis by contrast 2D echocardiography. Gut 1981; 12: 1042–1044.10.1136/gut.22.12.1042CrossRefGoogle Scholar
Ohuchi, H, Yasuda, K, Miyazaki, A, et al.Haemodynamic characteristics before and after the onset of protein losing enteropathy in patients after the Fontan operation. Eur J Cardiothorac Surg 2013; 3: e49–e57.10.1093/ejcts/ezs714CrossRefGoogle Scholar
Cloutier, A, Ash, JM, Smallhorn, JF, et al.Abnormal distribution of pulmonary blood flow after the Glenn shunt or Fontan procedure: risk of development of arteriovenous fistulae. Circulation 1985; 72: 471–479.10.1161/01.CIR.72.3.471CrossRefGoogle ScholarPubMed
Srivastava, D, Preminger, T, Lock, JE, et al.Hepatic venous blood and development of pulmonary arteriovenous malformations in congenital heart disease. Circulation 1995; 92: 1217–1222.10.1161/01.CIR.92.5.1217CrossRefGoogle ScholarPubMed
Barbé, T, Losay, J, Grimon, G, et al.Pulmonary arteriovenous shunting in children with liver disease. J Pediatr 1995; 126: 571–579.10.1016/S0022-3476(95)70351-9CrossRefGoogle ScholarPubMed
Moore, JW, Kirby, WC, Madden, WA, Gaither, NS.Development of pulmonary arteriovenous malformation after Fontan operations. J Thorac Cardiovasc Surg 1989; 98: 1045–1050.10.1016/S0022-5223(19)34317-XCrossRefGoogle ScholarPubMed
Bommer, WJ, Shah, PM, Allen, H, Meltzer, R, Kisslo, J.The safety of contrast echocardiography: report of the Committee on Contrast Echocardiography for the American Society of Echocardiography. J Am Coll Cardiol 1984; 3: 6–13.10.1016/S0735-1097(84)80423-4CrossRefGoogle Scholar
Roelandt, J.Contrast echocardiography. Ultrasound Med Biol 1982; 8: 471–492.10.1016/0301-5629(82)90079-5CrossRefGoogle ScholarPubMed
Dokumcu, Z, Ozcan, C, Alper, H, Erdener, A.Pulmonary arteriovenous malformation in children. Pediatr Int 2015; 57: 708–711.10.1111/ped.12564CrossRefGoogle ScholarPubMed
Ohuchi, H, Yasuda, K, Miyazaki, A, et al.Haemodynamic characteristics before and after the onset of protein losing enteropathy in patients after the Fontan operation. Eur J Cardiothorac Surg 2013; 43: e49–e57.10.1093/ejcts/ezs714CrossRefGoogle ScholarPubMed