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Screening and diagnostic imaging at centres performing congenital heart surgery in middle-income countries

Published online by Cambridge University Press:  10 June 2022

Amara Majeed Open the ORCID record for Amara Majeed [Opens in a new window] ,
Kathy Jenkins ,
Kimberlee Gauvreau ,
Julian F. Forero ,
Fabiola Pérez Juárez ,
Snehal Kulkarni ,
Vu Minh Phuc  and
David Schidlow
Amara Majeed*
Affiliation:
Departments of Cardiology, Harvard Medical School, Boston, MA, USA Boston Children’s Hospital, and Pediatrics, Harvard Medical School, Boston, MA, USA
Kathy Jenkins
Affiliation:
Departments of Cardiology, Harvard Medical School, Boston, MA, USA Boston Children’s Hospital, and Pediatrics, Harvard Medical School, Boston, MA, USA
Kimberlee Gauvreau
Affiliation:
Departments of Cardiology, Harvard Medical School, Boston, MA, USA Boston Children’s Hospital, and Pediatrics, Harvard Medical School, Boston, MA, USA
Julian F. Forero
Affiliation:
Fundacion Cardioinfantil, Universidad del Rosario, Bogota, Colombia
Fabiola Pérez Juárez
Affiliation:
National Institute of Pediatric, Mexico City, Mexico
Snehal Kulkarni
Affiliation:
Kokilaben Dhirubhai Ambani Hospital, Andheri West, Mumbai, India
Vu Minh Phuc
Affiliation:
Children’s Hospital, Ho Chi Minh City, Vietnam
David Schidlow
Affiliation:
Departments of Cardiology, Harvard Medical School, Boston, MA, USA Boston Children’s Hospital, and Pediatrics, Harvard Medical School, Boston, MA, USA
*
Address for correspondence: Amara Majeed, Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA. Tel: 617-355-7186; Fax: 617-730-0710. E-mail: amara.majeed@cardio.chboston.org
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Abstract

Background:

Surgical care for CHD is increasingly available in low- and middle-income countries, and efforts to optimise outcomes are growing. This study characterises cardiac imaging and prenatal diagnosis infrastructure in this setting.

Methods:

An infrastructure survey was administered to sites participating in the International Quality Improvement Collaborative for CHD. Questions regarding transthoracic, transesophageal and epicardial echocardiography, cardiac CT, cardiac magnetic resonance, prenatal screening and fetal echocardiography were included. Associations with in-hospital and 30-day mortality were assessed.

Results:

Thirty-seven sites in 17 countries responded. Programme size and geography varied considerably: < 250 cases (n = 13), 250–500 cases (n = 9), > 500 cases (n = 15); Americas (n = 13), Asia (n = 18), and Eastern Europe (n = 6). All had access to transthoracic echo. Most reported transesophageal and epicardial echocardiography availability (86 and 89%, respectively). Most (81%) had cardiac CT, but only 54% had cardiac magnetic resonance. A third reported impediments to imaging, including lack of portable machines, age/size-appropriate equipment and advanced cardiac imaging access and training. Only 19% of centres reported universal prenatal CHD screening in their catchment area, and only 46% always performed fetal echocardiography if screening raised concern for CHD. No statistically significant associations were identified between imaging modality availability and surgical outcomes.

Conclusions:

Although access to echocardiography is available in most middle-income countries; advanced imaging modalities (cardiac CT and magnetic resonance) are not always accessible. Prenatal screening for CHD is low, and availability of fetal echocardiography is limited. Imaging infrastructure in low- and middle-income countries and associations with outcomes merits additional study.

Keywords

Cardiac imagingCHDmiddle-income countries
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 5 , May 2023 , pp. 780 - 786
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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