Paediatric follow-up of haemodynamically insignificant congenital cardiac lesions

Authors


Dr Shakeel A Qureshi, Department of Congenital Heart Disease, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Lambeth Palace Road, London SE1 7EH, United Kingdom. Fax: +20 7188 4556; email: shakeel.qureshi@gstt.nhs.uk

Abstract

Aim:  To describe the prevailing follow-up of haemodynamically insignificant congenital cardiac lesions (HICCL) in the UK. To suggest a rationalisation of follow-up based on the known natural history of these lesions.

Methods:  An internet-based survey of 170 paediatric cardiologists and general paediatricians with an interest in cardiology in the UK. Five scenarios concerning common HICCL were presented: ventricular and atrial septal defects, patent foramen ovale, mild pulmonary stenosis and persistent ductus arteriosus.

Results:  There were 52 respondents. There was a broad range of beliefs and practices. However, there were tendencies to discharge children with a patent foramen ovale and follow patients with all other lesions, often on a relatively frequent basis.

Conclusions:  The increasingly sensitive and advanced nature of echocardiography and the subsequent reliance upon it may be contributing to unnecessarily frequent review of HICCL and a reluctance to discharge patients. In the majority of patients with HICCL, no more than two assessments of HICCL are required after 2 years of age – once in late childhood and once near full growth.

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