Con: Pediatric anesthesiologists should not be the primary echocardiographers for pediatric patients undergoing cardiac surgical procedures

Major errors were found in 44%, moderate errors in 28%, and minor errors in 12% in the adult laboratories. In the pediatric echocardiography laboratory, there were major errors in 0%, moderate errors in 4%, and minor errors in 4% of patients. When duplicate echocardiographic studies were available, the rates of major, moderate, and minor errors in adult laboratories were 12%, 29%, and 12%. There were no errors in the studies performed by pediatric echocardiographers. Of the errors made in the adult echocardiography laboratories, 71% were interpretive, 17% were technical, and 11% were both. Error incidences were not related to patient age, study year, use of color Doppler, or complexity of diagnoses. In total, moderate or major errors were noted in 35 of 65 patients. In 29 of the 35 patients, subsequent echocardiograms performed in a pediatric laboratory resulted in altered clinical management, including 12 surgeries and 2 averted cardiac operations. In 3 of the 29 patients, delayed diagnoses were associated with fixed pulmonary vascular disease, hypoxemic spells, and vascular collapse with severe metabolic acidosis. These findings support the importance of thorough training in pediatric echocardiography in a suitable high-volume laboratory.