Echocardiography and cardiac catheterization in the preoperative assessment of ventricular septal defect in infancy

Abstract Background Cardiac catheterization is commonly performed before repair of ventricular septal defect (VSD) in infancy. No study has addressed the accuracy of echocardiography alone in defining all of the important anatomic features in this population. Methods Consecutive infants undergoing VSD repair between 1991 and 1995 ( n = 156) were reviewed. The number of additional VSDs and the presence of commonly associated lesions were recorded for each technique and compared with a reference standard consisting of a combination of surgical findings plus postoperative echocardiography and clinical findings. The associated lesions were right ventricular muscle bundles, subaortic ridge, and persistent ductus arteriosus. Results The sensitivity and specificity of echocardiography in the detection of additional VSDs was 60% and 99% compared with 53% and 97% for cardiac catheterization and 73% and 96% for both techniques. These differences were not statistically significant. No differences were seen in the detection of commonly associated lesions. Conclusion Routine preoperative cardiac catheterization for infants with a primary diagnosis of VSD is probably no longer justified. Am Heart J 1998;135:907-13.)