Dr. Victor Grech
Paediatric Senior Registrar
St. Lukes Hospital
Ms. Rachel Danvers
Chief Echocardiography Technician
Great Ormond Street Hospital for Children NHS Trust
London WC1N 3JH
Dr. Victor Grech
Surface mail address - as above
Echocardiography has revolutionised the practice of paediatric cardiology by allowing non-invasive diagnosis and follow-up of a wide variety of conditions, particularly congenital heart disease (CHD) - allowing patients to be diagnosed, followed-up and even operated without invasive investigations (1,2). Echocardiography machines have become highly sophisticated and versatile pieces of equipment. This article illustrates non-CHD applications of echocardiography in the setting of a tertiary paediatric cardiac referral centre.
Images were obtained by Acuson XP-10, Acuson Sequoia and Toshiba SSH654 machines from patients referred to the Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Trust. All graphics were downloaded to conventional photographic paper, and then converted to digital images using a Hewlett Packard Scanjet IICX. The images were annotated using Paint Shop Pro. Cropping and contrast adjustments were made using Adobe Photoshop.
Right atrial thrombus (4).
Wilm's tumour with extension to right atrium (5).
Extracardiac intracirculatory masses
Thrombus formation in the innominate vein after bidirectional Glenn procedure for tricuspid atresia (6).
Pericardial effusion with fibrin formation (7).
Bilateral pleural effusions (8).
Localisation of central lines and associated thrombi/vegetations
Umbilical arterial line in descending aorta seen both in short axis and long axis aortic views (9).
Infected ventriculo-arterial shunt with vegetation formation at tip of shunt in right atrium (10).
Extra-corporeal life support cannulae
Extra-corporeal life support venous cannula in superior vena cava extending to the right atrium.
Arterial cannula in apex of aortic arch (11).
Arteriovenous malformations causing heart failure due to extracardiac left-to-right shunting (12)
Diagnosis of post-operative diaphragmatic paralysis.
Unilateral and even bilateral, partial or complete diaphragmatic paralysis due to trauma to the phrenic nerve, is an occasional complication of surgery for CHD. Upward and downward movement of the diaphragm in expiration and inspiration respectively, can be screened in real-time both ultrasonographically and fluoroscopically. The left and right components of the diaphragm can be viewed simultaneously from the subcostal window by US allowing paradoxical movement to be visualised in ventilated patients with unilateral diaphragmatic paralysis (13).
Cardiac applications of ultrasonography techniques have undergone tremendous strides since the inception of M-mode echocardiography. 2-dimensional echocardiography allows detailed intracardiac analysis of complex malformations, and the availability of pulse-wave Doppler and continuous-wave Doppler since the mid-1980s and colour Doppler since the late 1980s has allowed even more information to be gathered in the cardiac ultrasound examination (14). Full diagnosis, follow-up and even surgery of patients with CHD can be undertaken without resort to more invasive techniques in many individuals (1,2).
The images in this article illustrate how chocardiography has been utilized for the diagnosis and/or monitoring of non-congenital heart problems in a tertiary pediatric referral hospital (15).
Abstract on the use of echocardiography in a Canadian level three neonatal intensive care unit.
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