Determining the incidence of heart malformations in neonates: A novel and clinically approved solution.

Background: Screening for critical congenital heart defects should be performed as early as possible and is essential for saving the lives of children and reducing the incidence of undetected adult congenital heart diseases. Heart malformations remain unrecognized at birth in more than 50% of neonates at maternity hospitals. Accurate screening for congenital heart malformations is possible using a certified and internationally patented digital intelligent phonocardiography machine. This study aimed to assess the actual incidence of heart defects in neonates. A pre-evaluation of the incidence of unrecognized severe and critical congenital heart defects at birth in our well-baby nursery was also performed. Methods: We conducted the Neonates Cardiac Monitoring Research Project (ethics approval number: IR-IUMS-FMD. REC.1398.098) at the Shahid Akbarabadi Maternity Hospital. This study was a retrospective analysis of congenital heart malformations observed after screening 840 neonates. Using a double-blind format, 840 neonates from the well-baby nursery were randomly chosen to undergo routine clinical examinations at birth and digital intelligent phonocardiogram examinations. A pediatric cardiologist performed echocardiography for each neonate classified as having abnormal heart sounds using an intelligent machine or during routine medical examinations. If the pediatric cardiologist requested a follow-up examination, then the neonate was considered to have a congenital heart malformation, and the cumulative incidence was calculated accordingly. Results: The incidence of heart malformations in our well-baby nursery was 5%. Furthermore, 45% of heart malformations were unrecognized in neonates at birth, including one critical congenital heart defect. The intelligent machine interpreted innocent murmurs as healthy heart sound. Conclusion: We accurately and cost-effectively screened for congenital heart malformations in all neonates in our hospital using a digital intelligent phonocardiogram. Using an intelligent machine, we successfully identified neonates with CCHD and congenital heart defects that could not be detected using standard medical examinations. The Pouya Heart machine can record and analyze sounds with a spectral power level lower than the minimum level of the human hearing threshold. Furthermore, by redesigning the study, the identification of previously unrecognized heart malformations could increase to 58%.

Distinguishing Septal Heart Defects from the Valvular Regurgitation Using Intelligent Phonocardiography.

This paper presents an original machine learning method for extracting diagnostic medical information from heart sound recordings. The method is proposed to be integrated with an intelligent phonocardiography in order to enhance diagnostic value of this technology. The method is tailored to diagnose children with heart septal defects, the pathological condition which can bring irreversible and sometimes fatal consequences to the children. The study includes 115 children referrals to an university hospital, consisting of 6 groups of the individuals: atrial septal defects (10), healthy children with innocent murmur (25), healthy children without any murmur (25), mitral regurgitation (15), tricuspid regurgitation (15), and ventricular septal defect (25). The method is trained to detect the atrial or ventricular septal defects versus the rest of the groups. Accuracy/sensitivity and the structural risk of the method is estimated to be 91.6%/88.4% and 9.89%, using the repeated random sub sampling and the A-Test method, respectively.

An Edge Computing Method for Extracting Pathological Information from Phonocardiogram.

This paper presents a structure of decision support system for pediatric cardiac disease, based on an Internet of Things (IoT) framework. The structure performs the intelligent decision making at its edge processing level, which classifies the heart sound signal, to three classes of cardiac conditions, normal, mild disease, and critical disease. Three types of the errors are introduced to evaluate the performance of the processing method, Type 1, 2 and 3, defined as the incorrect classification from the critical disease, mild, and normal, respectively. The method is validated using 140 real data patient records collected from the hospital referrals. The estimated negative errors for the Type 1, and 2, are calculated to be 0% and 4.8%, against the positive errors which are 6.3% and 13.3%, respectively. The Type 3, is calculated to be 16.7%, showing a high sensitivity of the method to be used in an IoT healthcare framework.

Intelligent Phonocardiography for Screening Ventricular Septal Defect Using Time Growing Neural Network.

This paper presents results of a study on the applicability of the intelligent phonocardiography in discriminating between Ventricular Spetal Defect (VSD) and regurgitation of the atrioventricular valves. An original machine learning method, based on the Time Growing Neural Network (TGNN), is employed for classifying the phonocardiographic recordings collected from the pediatric referrals to a children hospital. 90 individuals, 30 VSD, 30 with the valvular regurgitation, and 30 healthy subjects, participated in the study after obtaining the informed consents. The accuracy and sensitivity of the approach is estimated to be 86.7% and 83.3%, respectively, showing a good performance to be used as a decision support system.

An Intelligent Phonocardiography for Automated Screening of Pediatric Heart Diseases.

This paper presents a robust device for automated screening of pediatric heart diseases based on our unique processing method in murmur characterization; the Arash-Band method. The present study modifies the Arash-Band method and employs output of the modified method in conjunction with the two other original techniques to extract indicative feature vectors for the screening. The extracted feature vectors are classified by using the support vector machine method. Results show that the proposed modifications significantly enhances performance of the Arash-Band in terms of the both accuracy and sensitivity as the corresponding effect sizes are sufficiently large. The proposed algorithm has been incorporated into an Android-based tablet to constitute an intelligent phonocardiogram with the automatic screening capability. In order to obtain confidence interval of the accuracy and sensitivity, an inferable statistical test is applied on our database containing the phonocardiogram signals recorded from 263 of the referrals to a hospital. The expected value of the accuracy/sensitivity is estimated to be 87.45 % / 87.29 % with a 95 % confidence interval of (80.19 % - 92.47 %) / (76.01 % - 95.78 %) exhibiting superior performance than a pediatric cardiologist who relies on conventional or even computer-assisted auscultation.

A Novel Method for Screening Children with Isolated Bicuspid Aortic Valve.

This paper presents a novel processing method for heart sound signal: the statistical time growing neural network (STGNN). The STGNN performs a robust classification by merging supervised and unsupervised statistical methods to overcome non-stationary behavior of the signal. By combining available preprocessing and segmentation techniques and the STGNN classifier, we build an automatic tool for screening children with isolated BAV, the congenital heart malformation which can lead to serious cardiovascular lesions. Children with BAV (22 individuals) and healthy condition (28 individuals) are subjected to the study. The performance of the STGNN is compared to that of a time growing neural network (CTGNN) and a conventional support vector (CSVM) machine, using balanced repeated random sub sampling. The average of the accuracy/sensitivity is estimated to be 87.4/86.5 for the STGNN, 81.8/83.4 for the CTGNN, and 72.9/66.8 for the CSVM. Results show that the STGNN offers better performance and provides more immunity to the background noise as compared to the CTGNN and CSVM. The method is implementable in a computer system to be employed in primary healthcare centers to improve the screening accuracy.

A novel method for pediatric heart sound segmentation without using the ECG.

In this paper, we propose a novel method for pediatric heart sounds segmentation by paying special attention to the physiological effects of respiration on pediatric heart sounds. The segmentation is accomplished in three steps. First, the envelope of a heart sounds signal is obtained with emphasis on the first heart sound (S(1)) and the second heart sound (S(2)) by using short time spectral energy and autoregressive (AR) parameters of the signal. Then, the basic heart sounds are extracted taking into account the repetitive and spectral characteristics of S(1) and S(2) sounds by using a Multi-Layer Perceptron (MLP) neural network classifier. In the final step, by considering the diastolic and systolic intervals variations due to the effect of a child's respiration, a complete and precise heart sounds end-pointing and segmentation is achieved.

Computerized screening of children congenital heart diseases.

In this paper, we propose a method for automated screening of congenital heart diseases in children through heart sound analysis techniques. Our method relies on categorizing the pathological murmurs based on the heart sections initiating them. We show that these pathelogical murmur categories can be identified by examining the heart sound energy over specific frequency bands, which we call, Arash-Bands. To specify the Arash-Band for a category, we evaluate the energy of the heart sound over all possible frequency bands. The Arash-Band is the frequency band that provides the lowest error in clustering the instances of that category against the normal ones. The energy content of the Arash-Bands for different categories constitue a feature vector that is suitable for classification using a neural network. In order to train, and to evaluate the performance of the proposed method, we use a training data-bank, as well as a test data-bank, collectively consisting of ninety samples (normal and abnormal). Our results show that in more than 94% of cases, our method correctly identifies children with congenital heart diseases. This percentage improves to 100%, when we use the Jack-Knife validation method over all the 90 samples.