The assessment for patient with duct-dependent pulmonary circulation (DDPC) during the inter-stage intervals before first
stage palliation commonly includes imaging of the heart with multiple imaging modalities. Recently, three-dimensional
echocardiography (3DE) was found with the ability to delineate cardiac structure that is able to do 360o
rotation. Therefore,
this study aimed at identifying the accuracy of 3DE colour flow in measuring PDA size compared to computer tomography
angiography (CTA). This study involves randomly selected 26 patients with DDPC undergoing CTA for palliation treatment
in one year. The mean patient age is 1.6 ± 0.261 months with mean weight of 3.65 ± 0.82 kg. The full-volume 3DE colour
flow acquisition was performed and analysed offline using Q-lab software. The PDA diameters at the origin as well as the
insertion site were measured. The data obtained by 3DE colour flow data were compared to the CTA, which was taken as
the gold standard. Results showed that the offline analysis of PDA size was feasible in all patients (100%) with the mean
diameter of PDA at the origin on 3DE colour flow and CTA of 0.51 mm ± 0.14 and 0.52 mm ± 0.11, respectively (p = 0.92)
. The PDA diameter at insertion site on 3DE colour flow and CTA was 0.29 mm ± 0.08 and 0.27 mm ± 0.97 respectively (p
= 0.5). Meanwhile, the measurement of 3DE colour flow is comparable to CTA in measurement PDA size. However, the use
of 3DE colour flow in infants with rapid heart rate is yet challenging to 3DE colour flow acquisitions.
The present study aims to determine the limitations of traditional Jones criteria during the first episode of acute rheu- matic fever (ARF) at the initial referral hospital, in a cohort of patients below 18 years old who had undergone mitral valve repair in National Heart Institute (IJN) from 2011 to 2016. Carditis followed by fever and joint involvement were the most frequent manifestations at first diagnosis. Of the 50 patients, only seven (14%) fulfilled the traditional Jones criteria for the diagnosis of the first episode of ARF. When compulsory evidence of a previous group A Beta he- molytic streptococcus (GABHS) was disregarded, this figure rose to 54%. Therefore, strict adherence to Jones criteria with absolute documentation of GABHS will lead to underdiagnoses of ARF. The application of echocardiographic diagnostic criteria of rheumatic heart disease (RHD) needs to be emphasized to allow early diagnosis and adminis- tration of secondary prophylaxis to prevent progression to severe valvular disease.