The agreement between two-dimensional echocardiographic findings and gross morphologic diagnoses on autopsies of pediatric patients with congenital heart disease performed at the Philippine Heart Center mortuary between 1998 to 2004 .

Background ÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ Major global decline in autopsy rates with increased confidence in imaging modalities and continuous proof that it provides clinically relevant information especially in pediatric cases are the significant trends in recent years. This study examines the usefulness of pediatric autopsy with focus in the morphologic evaluation of congenital heart disease spectrum. It will specifically compare the agreement of the different lesions identified by two-dimensional echocardiography as confirmed by the gross morphologic diagnoses on autopsy. This is to objectively present concrete findings and results that would contribute in the justification for the restoration of this valuable tool.

Methods and Results ÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ This is a cross-sectional study consisting of all pediatric autopsies evaluated for congenital heart disease performed at the Philippine Heart Center mortuary between 1998 to 2004. The degree of agreement on over-all autopsy diagnosis is descriptively presented by a devised grading criteria while the strength of agreement of the individual isolated lesions is evaluated by the kappa coefficient.

The two-dimensional echocardiography in the evaluation of Pulmonary Valve Atresia and Total Anomalous Pulmonary Venous Connection have 100 percent sensitivity, specificity, positive and negative predictive value while for Coarctation of Aorta and Persistent Left Superior Vena Cava, it has virtually no sensitivity and positive predictive values. Over-all, the diagnostic accuracy of the two-dimensional echocardiography in our setting in the diagnosis of congenital heart disease in children will give only 67 percent sensitivity, 54.8 percent specificity, 86.27 percent positive predictive value and 28.33 percent negative predictive value.

Conclusion ÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ There is fairly a good agreement between two-dimensional echocardiographic findings and gross morphologic diagnoses on pediatric autopsies of congenital heart disease. Missed individual lesions and discrepancies on diagnoses with probable therapeutic implications however still stand as problems. Thus, the autopsy should remain as a very important tool in the improvement in the diagnosis and future medical and surgical management especially among these type of patients. (Author)