Role of intraoperative transesophageal echocardiography in pediatric cardiac surgery

Background: Intraoperative transesophageal echocardiography [TEE] has a major role in detecting residual lesions during and/or after pediatric cardiac surgery

Methods: All pediatric patients who underwent cardiac surgery between July 2001 and December 2008 were reviewed. The records of surgical procedure, intraoperative TEE, and predischarge transthoracic echocardiograms were reviewed to determine minor and major residual cardiac lesions after surgical repair

Results: During the study period, a total of 2268 pediatric cardiac patients were operated in our center. Mean age was 21 months [from 1 day to 14 years]. Of these patients, 1016 [48%] had preoperative TEE and 1036 [46%] were evaluated by intraoperative echocardiography [TEE or epicardial study]. We identified variations between TEE and preoperative transthoracic echocardiography in 14 patients [1.3%]. Only one surgical procedure was cancelled after atrial septal defect exclusion. The other 13 patients had minor variation from their surgical plan. Major residual lesions requiring surgical revision were detected in 41 patients [3.9%], with the following primary diagnoses: tetralogy of Fallot in 12 patients [29%], atrioventricular septal defect in seven patients [17%], ventricular septal defect in seven patients [17%], double outlet right ventricle in two patients [5%], Shone complex in two patients [5%], subaortic stenosis in two patients [5%], mitral regurgitation in two patients [5%], pulmonary atresia in two patients [5%], and five patients [12%] with other diagnoses

Conclusion: Intraoperative TEE has a major impact in pediatric cardiac surgery to detect significant residual lesions. Preoperative TEE has a limited role in case of a high quality preoperative transthoracic echocardiography. We recommend routine use of intraoperative TEE during and/or after intracardiac repair in children

Routine intraoperative transesophageal echocardiography for pediatric open heart surgery: is it justifiable?

The routine use of intraoperative transesophageal echocardiography [IO TEE] in children is still debatable. The aim of this study was to determine the safety, benefit, and the possible risk of the routine use of IO TEE. IO TEE was performed in all children under the age of 14 years with complex congenital heart defects undergoing open heart surgery, from July 2001 to December 2002. Simple lesions such as secundum atrial septal defects or simple perimembranous ventricular septal defects [VSD], and neonates less than 2.7 kg were excluded. All children underwent a pre-repair and post-repair complete IO TEE study. There were 112 children, 65 males and 47 females. Ages ranged from 4 days to 156 month, a median of 9 months. A full study was not done in three neonates [3%] because the probe could not be inserted in one, and because of airway compression resulting in desaturation in another two. A pre-repair study confirmed the preoperative transthoracic echocardiographic findings in 105 children [95%]. Diagnostic discrepancy or unexpected lesions not reported preoperatively were found in 6 children [5%]. Of the 109 children who had full post-repair studies, 67 [60%] showed optimum repair with no residual lesions, and 26 [23%] showed trivial or mild residual lesions accepted by the team. Going back on pump to fix moderate or severe residual lesions occurred in 16 [14%] children. In all of these children, the decision for going back on pump was prompted by the IO TEE examination alone. Mild complications occurred in two children [2%]. Based on our results, we recommend the routine use of IO TEE. It is safe, has a low complication rate, adds additional information and has a high impact on the diagnosis of residual lesions required in the operating room. However, careful monitoring of the ventilation and airway pressure, particularly during probe insertion and manipulation in small children, is very essential