Assessment of the reasons prompting a first echocardiography in children: a Lebanese multicenter study

ABSTRACT

To study the different indications behind performance of a first Doppler echocardiography [DE] in children, to assess the results and their impact on the residency teaching program in Lebanon. Retrospective study over a 40-month period, from March 1[st], 2002, through June 30, 2005. Patients referred for the first DE were examined in different medical centers in Beirut, Mount-Lebanon and South Lebanon. 3137 new patients aged from 0 to 18 years [average 54 months] were included in the analysis. The percentage of patients seen as outpatients was 48% in departments of pediatrics and emergency rooms 38.2%; intensive care neonatal units 13%; and in maternity wards/nurseries 0.8%. 2198 patients [70.1%] had normal DE. Heart murmur accounts for 45.6% of DE requests, followed by extracardiac malformations and presence of dysmorphic features [7.2%], cyanosis [6.8%], suspicion of rheumatic fever [5.7%], cardiac arrhythmia [3.8%], bronchopneumopathies and respiratory distress [3.5%], chest pain and palpitations [3.3%]. Innocent murmur was found in 53.9% of patients referred for heart murmur among syndromes and malformations, Down's syndrome was the most frequent pathology, followed by poly malformations, the VACTERL syndrome and the cleft lip and palate. Cyanotic congenital heart disease was diagnosed in 34% of cases referred for cyanosis. The diagnosis of carditis was confirmed in 84.6% of children with clinical picture of rheumatic fever. In cases of malaise, dizziness and loss of consciousness, no abnormality was detected on DE. DE should be a complement to clinical exam, which is often sufficient to reveal a cardiac pathology. However, some conditions, where cardiovascular exam is normal require a DE. The question of when and why to request a DE must be a priority in the pediatric resident training program