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Pyra P, Hadeed K, Guitarte Vidaurre A, Vincent R, Dulac Y, Chausseray G, Calvaruso DF, Acar P, Karsenty C. Usefulness of perioperative transoesophageal echocardiography during paediatric cardiac surgery. Arch Cardiovasc Dis 2024; 117:177-185. [PMID: 38272760 DOI: 10.1016/j.acvd.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Paediatric transoesophageal echocardiography probes allow perioperative evaluation during paediatric congenital heart disease surgery. AIM To assess the usefulness of perioperative transoesophageal echocardiography in evaluating the severity of residual lesions, based on the type of congenital heart disease repaired in paediatric patients. METHODS A retrospective analysis was conducted on paediatric patients who underwent open-heart surgery at our tertiary centre over a four-year period. Perioperative transoesophageal echocardiography studies were performed, and residual lesions were classified as mild, moderate or severe. RESULTS Overall, 323 procedures involving 310 patients with a median age of 13.8 (0.07-214.4) months and a median weight of 8.2 (2-96) kg at intervention were enrolled in the study. Twenty-one (6.5%) residual lesions led to immediate reintervention: severe right ventricular outflow tract obstruction (n=12); severe aortic regurgitation (n=3); superior vena cava stenosis (n=2); moderate residual ventricular septal defect (n=2); severe mitral regurgitation (n=1); and severe mitral stenosis (n=1). Three (0.9%) neonates had ventilation difficulties caused by the transoesophageal echocardiography probe having to be removed, but experienced no sequelae. CONCLUSION Perioperative transoesophageal echocardiography is a safe procedure, providing information on severe residual lesions, leading to the immediate revision of several paediatric congenital heart disease cases.
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Affiliation(s)
- Pierrick Pyra
- Paediatric Cardiology Unit, Department of Paediatrics, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France.
| | - Khaled Hadeed
- Paediatric Cardiology Unit, Department of Paediatrics, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France
| | - Aitor Guitarte Vidaurre
- Paediatric Cardiology Unit, Department of Paediatrics, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France
| | - Rémi Vincent
- Paediatric Cardiology Unit, Department of Paediatrics, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France
| | - Yves Dulac
- Paediatric Cardiology Unit, Department of Paediatrics, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France
| | - Gérald Chausseray
- Department of Paediatric Anaesthesiology, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France
| | - Davide Felice Calvaruso
- Department of Congenital Cardiac Surgery, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France
| | - Philippe Acar
- Paediatric Cardiology Unit, Department of Paediatrics, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France
| | - Clément Karsenty
- Paediatric Cardiology Unit, Department of Paediatrics, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France; Inserm U1048, Institut des Maladies Métaboliques et Cardiovasculaires (Institute of Metabolic and Cardiovascular Diseases; I2MC), University of Toulouse, 31432 Toulouse, France
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2
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Left Atrioventricular Transvalvular Pressure Gradients Derived from Intraoperative and Postoperative Echocardiograms following Atrioventricular Septal Defect Repair. Diagnostics (Basel) 2023; 13:diagnostics13050957. [PMID: 36900100 PMCID: PMC10001237 DOI: 10.3390/diagnostics13050957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/25/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Left atrioventricular valve (LAVV) stenosis following an atrioventricular septal defect (AVSD) repair is a rare but potentially life-threatening complication. While echocardiographic quantification of diastolic transvalvular pressure gradients is paramount in the evaluation of a newly corrected valve function, it is hypothesized that these measured gradients are overestimated immediately following a cardiopulmonary bypass (CPB) due to the altered hemodynamics when compared to postoperative valve assessments using awake transthoracic echocardiography (TTE) upon recovery after surgery. METHODS Out of the 72 patients screened for inclusion at a tertiary center, 39 patients undergoing an AVSD repair with both intraoperative transesophageal echocardiograms (TEE, performed immediately after a CPB) and an awake TTE (performed prior to hospital discharge) were retrospectively selected. The mean (MPGs) and peak pressure gradients (PPGs) were quantified using a Doppler echocardiography and other measures of interest were recorded (e.g., a non-invasive surrogate of the cardiac output and index (CI), left ventricular ejection fraction, blood pressures and airway pressures). The variables were analyzed using the paired Student's t-tests and Spearman's correlation coefficients. RESULTS The MPGs were significantly higher in the intraoperative measurements when compared to the awake TTE (3.0 ± 1.2 vs. 2.3 ± 1.1 mmHg; p < 0.01); however, the PPGs did not significantly differ (6.6 ± 2.7 vs. 5.7 ± 2.8 mmHg; p = 0.06). Although the assessed intraoperative heart rates (HRs) were also higher (132 ± 17 vs. 114 ± 21 bpm; p < 0.001), there was no correlation found between the MPG and the HR, or any other parameter of interest, at either time-point. In a further analysis, a moderate to strong correlation was observed in the linear relationship between the CI and the MPG (r = 0.60; p < 0.001). During the in-hospital follow-up period, no patients died or required an intervention due to LAVV stenosis. CONCLUSIONS The Doppler-based quantification of diastolic transvalvular LAVV mean pressure gradients using intraoperative transesophageal echocardiography seems to be prone to overestimation due to altered hemodynamics immediately after an AVSD repair. Thus, the current hemodynamic state should be taken into consideration during the intraoperative interpretation of these gradients.
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Alrayashi W, Kelleher S, DiNardo J, Kovatsis P, Clarke W, Hickey P, Park R. Hands-free continuous transthoracic echocardiography: A contemporary evolution of the precordial stethoscope. Paediatr Anaesth 2021; 31:616-618. [PMID: 33482049 DOI: 10.1111/pan.14140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Walid Alrayashi
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Stephen Kelleher
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - James DiNardo
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Pete Kovatsis
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - William Clarke
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Paul Hickey
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Raymond Park
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
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4
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Hubbard RM, Santiago G, Uppu S, Roy S, Gautam N. Diagnosis of Extrinsic Upper Esophageal Compression Utilizing Video Laryngoscopy in an Infant Following Failed Transesophageal Echocardiogram Probe Placement. Semin Cardiothorac Vasc Anesth 2020; 24:360-363. [PMID: 32936056 DOI: 10.1177/1089253220954692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Anesthesiologists are frequently responsible for placement of transesophageal echocardiography probes prior to cardiac surgery in children. A number of potential complications are possible, including placement failure. This report documents one such failed attempt at probe placement in a 3-month-old patient with a history of ventricular septal defect, and the utilization of video laryngoscopy by the anesthesiologist to diagnose a previously unknown extrinsic esophageal compression likely caused by an aberrant right subclavian artery. This case highlights the multiple vascular anomalies that may act as a source of esophageal obstruction in children undergoing transesophageal echocardiography for cardiac surgery.
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Affiliation(s)
| | | | - Santosh Uppu
- University of Texas Health Science Center, Houston, TX, USA
| | - Soham Roy
- University of Texas Health Science Center, Houston, TX, USA
| | - Nischal Gautam
- University of Texas Health Science Center, Houston, TX, USA
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Williams T, Lluri G, Boyd EK, Kratzert WB. Perioperative Echocardiography in the Adult With Congenital Heart Disease. J Cardiothorac Vasc Anesth 2020; 34:1292-1308. [PMID: 32001150 DOI: 10.1053/j.jvca.2019.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 11/22/2019] [Accepted: 11/27/2019] [Indexed: 01/09/2023]
Abstract
Survival of patients with congenital heart disease has significantly improved over the last 2 decades, confronting interventionalists, surgeons, anesthesiologists, cardiologists, and intensivists with often unfamiliar complex pathophysiology in the perioperative setting. Aside from cardiac catheterization, echocardiography has become the main imaging modality in the hospitalized adult with congenital heart disease. The great variety of congenital lesions and their prior surgical management challenges practitioners to generate optimal imaging, reporting, and interpretation of these complex anatomic structures. Standardization of echocardiographic studies can not only provide significant benefits in the surveillance of these patients, but also facilitate understanding of pathophysiologic mechanism and assist clinical management in the perioperative setting. Knowledge in obtaining and interpreting uniform imaging protocols is essential for the perioperative clinician. In this publication, the authors review current international consensus recommendations on echocardiographic imaging of adults with congenital heart disease and describe the fundamental components by specific lesion. The authors will emphasize key aspects pertinent to the clinical management when imaging these patients in the perioperative setting. The goal of this review is to familiarize the perioperative physician on how to structure and standardize echocardiographic image acquisition of congenital heart disease anatomy for optimal clinical management.
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Affiliation(s)
- Tiffany Williams
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Gentian Lluri
- Ahmanson/UCLA ACHD Center, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Eva K Boyd
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Wolf B Kratzert
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
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6
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Murphy T. Anesthetist-delivered intraoperative transesophageal echocardiography in pediatric cardiac surgery. Paediatr Anaesth 2019; 29:499-505. [PMID: 30592106 DOI: 10.1111/pan.13572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/03/2018] [Accepted: 12/24/2018] [Indexed: 11/30/2022]
Abstract
This article reviews the evidence for anesthetist-delivered perioperative transesophageal echocardiography for children undergoing cardiac surgery. It addresses the additional issues of training, developing practice, accreditation, and the requirement for collaboration with pediatric cardiologists, surgeons and other members of the perioperative team. Finally an overview of the potential structure of an anesthetist-delivered perioperative transesophageal echocardiography service is presented.
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Affiliation(s)
- Tim Murphy
- Bristol Royal Hospital for Children, Bristol, UK
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7
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Puchalski MD, Lui GK, Miller-Hance WC, Brook MM, Young LT, Bhat A, Roberson DA, Mercer-Rosa L, Miller OI, Parra DA, Burch T, Carron HD, Wong PC. Guidelines for Performing a Comprehensive Transesophageal Echocardiographic. J Am Soc Echocardiogr 2019; 32:173-215. [DOI: 10.1016/j.echo.2018.08.016] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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8
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Amedro P, Gavotto A, Gelibert D, Fraysse V, De La Villeon G, Vandenberghe D, Bredy C. Feasibility of clinical hypnosis for transesophageal echocardiography in children and adolescents. Eur J Cardiovasc Nurs 2018; 18:163-170. [PMID: 30230358 DOI: 10.1177/1474515118803513] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The use of hypnosis in children has been described more than two centuries ago, with a more recent research and clinical application. There is currently a good level of evidence for the efficacy of clinical hypnosis in children for minor surgery, medical procedures or pain management. The use of clinical hypnosis, in paediatric cardiology, for invasive procedures such as transesophageal echocardiography, has not been reported. AIMS This study evaluated the feasibility of clinical hypnosis in children undergoing transesophageal echocardiography. METHOD This prospective, non-randomised, cross-sectional study was carried out over 24 months in a paediatric cardiology referral centre. All children aged 10-18 years requiring a transesophageal echocardiography examination, outside the operating room and the catheterisation laboratory, were eligible for the study. Children and families could choose between transesophageal echocardiography under clinical hypnosis or under general anaesthesia (<15 years) or sedation (⩾15 years). RESULTS We included 16 children aged 11-18 years (seven girls, mean age 14.1±2.5 years). The hypnotic state was achieved for 15 out of the 16 participating children (94%). The transesophageal echocardiography examination could be completely achieved with a full diagnosis for 15 out of 16 children (94%). In all cases, a transesophageal echocardiography examination under clinical hypnosis provided a complete diagnosis. CONCLUSION This study demonstrated that hypnosis was feasible and effective for transesophageal echocardiography in adolescents and might be a good alternative to general anaesthesia. Further study with larger numbers of subjects and more diverse congenital cardiac conditions are needed to confirm the results in a more diverse sample.
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Affiliation(s)
- Pascal Amedro
- 1 Pediatric and Congenital Cardiology Department, CHU Montpellier, France.,2 PHYMEDEXP, CNRS, INSERM, University of Montpellier, France
| | - Arthur Gavotto
- 1 Pediatric and Congenital Cardiology Department, CHU Montpellier, France
| | | | | | | | | | - Charlene Bredy
- 1 Pediatric and Congenital Cardiology Department, CHU Montpellier, France
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Ozturk E, Cansaran Tanidir I, Ayyildiz P, Gokalp S, Candas Kafali H, Sahin M, Ergul Y, Haydin S, Guzeltas A. The role of intraoperative epicardial echocardiography in pediatric cardiac surgery. Echocardiography 2018; 35:999-1004. [DOI: 10.1111/echo.13874] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Erkut Ozturk
- Department of Pediatric Cardiology; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center; University of Health Sciences; Istanbul Turkey
- Gelisim Universitesi; Istanbul Turkey
| | - Ibrahim Cansaran Tanidir
- Department of Pediatric Cardiology; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center; University of Health Sciences; Istanbul Turkey
| | - Pelin Ayyildiz
- Department of Pediatric Cardiology; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center; University of Health Sciences; Istanbul Turkey
| | - Selman Gokalp
- Department of Pediatric Cardiology; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center; University of Health Sciences; Istanbul Turkey
| | - Hasan Candas Kafali
- Department of Pediatric Cardiology; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center; University of Health Sciences; Istanbul Turkey
| | - Murat Sahin
- Department of Pediatric Cardiology; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center; University of Health Sciences; Istanbul Turkey
| | - Yakup Ergul
- Department of Pediatric Cardiology; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center; University of Health Sciences; Istanbul Turkey
| | - Sertac Haydin
- Pediatric Cardiovascular Surgery; Istanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Alper Guzeltas
- Department of Pediatric Cardiology; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center; University of Health Sciences; Istanbul Turkey
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10
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Vida VL, Zanotto L, Carrozzini M, Padalino MA, Stellin G. Repair Techniques for Mitral Valve Insufficiency in Children. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2018; 21:41-45. [PMID: 29425524 DOI: 10.1053/j.pcsu.2017.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/06/2017] [Indexed: 06/08/2023]
Abstract
Congenital mitral valve (MV) dysplasia is a relatively rare and highly complex cardiac disease. We sought to provide a comprehensive analysis of the current surgical techniques for treating mitral valve insufficiency and the results of mitral valve repair at our institution. Between 1972 and 2017, 104 consecutive patients underwent surgical repair of congenital MV dysplasia-insufficiency at our institution. Among these, 59 patients presented with MV insufficiency (or prevalent MV insufficiency) and were part of the study. There was 1 early (1.7%) and 1 late death (1.7%). Survival at 5, 10 and 20 years was 98%, 98% and 94%, respectively. Eight patients (14%) required MV replacement for residual significant MV insufficiency. Freedom from re-intervention for MV dysfunction at 5, 10 and 20 years were 89%, 84% and 79%, respectively. Surgical techniques for treating mitral valve insufficiency must be tailored for each patient with the main goal of achieving a proper valve function, rather than a "normal" anatomy. The mechanism underlying valve dysfunction in congenital mitral valve insufficiency is multifactorial and requires the application of a variety of surgical techniques in each case.
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Affiliation(s)
- Vladimiro L Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Lorenza Zanotto
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Massimiliano Carrozzini
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Massimo A Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Giovanni Stellin
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy..
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Michel J, Hofbeck M, Schineis C, Kumpf M, Heimberg E, Magunia H, Schmid E, Schlensak C, Blumenstock G, Neunhoeffer F. Severe Upper Airway Obstruction After Intraoperative Transesophageal Echocardiography in Pediatric Cardiac Surgery: A Retrospective Analysis. Pediatr Crit Care Med 2017; 18:924-930. [PMID: 28654552 DOI: 10.1097/pcc.0000000000001252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate if there is a correlation between the use of intraoperative transesophageal echocardiography and an increased rate of extubation failure and to find other risk factors for severe upper airway obstructions after pediatric cardiac surgery. DESIGN Retrospective analysis. SETTING Cardiac PICU. PATIENTS Patients 24 months old or younger who underwent surgery for congenital heart disease with cardiopulmonary bypass were retrospectively enrolled and divided into two groups depending on whether they received an intraoperative transesophageal echocardiography or not. We analyzed all cases of early reintubations within 12 hours after extubation due to a documented upper airway obstruction. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS From a total of 424 patients, 12 patients (2.8%) met our criteria of early reintubation due to upper airway obstruction. Ten of 207 children in the transesophageal echocardiography group had to be reintubated, whereas only two of the 217 children in the control group had to be reintubated (4.8% vs 0.9%; p = 0.018). Logistic regression analysis showed a significant correlation between use of intraoperative transesophageal echocardiography and extubation failure (odds ratio, 5.64; 95% CI, 1.18-27.05; p = 0.030). There was no significant relationship among sex (odds ratio, 4.53; 95% CI, 0.93-22.05; p = 0.061), weight (odds ratio, 1.07; 95% CI, 0.82-1.40; p = 0.601), duration of surgery (odds ratio, 1.04; 95% CI, 0.74-1.44; p = 0.834), duration of mechanical ventilation (odds ratio, 1.00; 95% CI, 0.99-1.00; p = 0.998), and occurrence of trisomy 21 (odds ratio, 3.47; 95% CI, 0.83-14.56; p = 0.089). CONCLUSIONS Although the benefits of intraoperative transesophageal echocardiography during pediatric cardiac surgery are undisputed, it may be one factor which could increase the rate of severe upper airway obstruction after extubation with the need for reintubation. We suggest to take precautions before extubating high-risk patients, especially in young male children with genetic abnormalities after cardiac surgery with cardiopulmonary bypass.
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Affiliation(s)
- Jörg Michel
- 1Department of Pediatric Cardiology, Pulmology, and Pediatric Intensive Care Medicine, University Children's Hospital Tuebingen, Tuebingen, Germany. 2Department of Anesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Tuebingen, Germany. 3Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen, Germany. 4Institute for Clinical Epidemiology and Applied Biometry, Eberhard Karls University Tuebingen, Tuebingen, Germany
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Abstract
The spectrum of congenital heart disease (CHD) seen in the adult varies widely. Malformations range from mild anomalies requiring no intervention to extremely complex pathologies characterized by the presence of multiple coexistent defects. Echocardiography represents the primary noninvasive imaging modality in the assessment of these lesions. The transesophageal approach expands the applications of echocardiography by allowing the acquisition of anatomic and functional information that may not be obtainable by transthoracic imaging.
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Affiliation(s)
- Rupa Sreedhar
- Department of Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Ayyildiz P, Güzeltaş A, Tanidir İC, Kasar T, Öztürk E, Ergül Y. Transesophageal echocardiography experience in thepediatric age group in a tertiary cardiac center. Turk J Med Sci 2016; 46:1155-61. [PMID: 27513419 DOI: 10.3906/sag-1507-81] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/02/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The aim of this study was to evaluate the transesophageal echocardiography (TEE) findings of pediatric patients in a tertiary center where complex congenital heart surgery and interventional procedures have been performed. MATERIALS AND METHODS All TEE studies performed between December 2009 and December 2014 were reviewed retrospectively. Patients were divided into 3 groups: perioperative, during interventional procedures, and due to other reasons. Demographic features, transthoracic echocardiography (TTE) reports, TEE reports, change in decision after TEE evaluation, and related complications were recorded. RESULTS A total of 703 patients who had TEE evaluation were included in the study; 51% were female and 49% were male. The median age was 90 months (2 months to 18 years). TEE was performed perioperatively in 430 patients (61%), during cardiac catheterization-angiography and electrophysiology studies in 181 patients (26%), and due to other reasons in 92 patients (13%). Mismatches between TTE and TEE or changes in decision after TEE evaluation were present in 45 patients (10.4%) who had perioperative TEE, in 10 patients (5.5%) who had TEE during interventional procedures, and 22 patients (24%) who had TEE evaluation due to other reasons. No major complications were detected. CONCLUSION Information acquired by TEE increases the clarity of future plans for the patient and helps to decrease the mortality and morbidity caused by unnecessary procedures.
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Affiliation(s)
- Pelin Ayyildiz
- Department of Pediatric Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Research, and Training Hospital, İstanbul, Turkey
| | - Alper Güzeltaş
- Department of Pediatric Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Research, and Training Hospital, İstanbul, Turkey
| | - İbrahim Cansaran Tanidir
- Department of Pediatric Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Research, and Training Hospital, İstanbul, Turkey
| | - Taner Kasar
- Department of Pediatric Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Research, and Training Hospital, İstanbul, Turkey
| | - Erkut Öztürk
- Department of Pediatric Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Research, and Training Hospital, İstanbul, Turkey
| | - Yakup Ergül
- Department of Pediatric Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Research, and Training Hospital, İstanbul, Turkey
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14
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Calais J, Edet-Sanson A, Gaucher S, Vera P, Le Cloirec J. Tc-99m-HMPAO-Labeled Leukocyte SPECT/CT in Pediatrics: Detecting Candida albicans Tricuspid Endocarditis. Nucl Med Mol Imaging 2015; 49:333-4. [DOI: 10.1007/s13139-015-0333-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 02/04/2015] [Accepted: 03/10/2015] [Indexed: 11/24/2022] Open
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15
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Garisto C, Favia I, Ricci Z, Romagnoli S, Haiberger R, Polito A, Cogo P. Pressure recording analytical method and bioreactance for stroke volume index monitoring during pediatric cardiac surgery. Paediatr Anaesth 2015; 25:143-9. [PMID: 24491036 DOI: 10.1111/pan.12360] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND It is currently uncertain which hemodynamic monitoring device reliably measures stroke volume and tracks cardiac output changes in pediatric cardiac surgery patients. OBJECTIVE To evaluate the difference between stroke volume index (SVI) measured by pressure recording analytical method (PRAM) and bioreactance and their ability to track changes after a therapeutic intervention. METHODS A single-center prospective observational cohort study in children undergoing cardiac surgery with cardiopulmonary bypass (CPB) was conducted. Twenty children below 20 kg with median (interquartile range) weight of 5.3 kg (4.1-7.8) and age of 6 months (3-20) were enrolled. Data were collected after anesthesia induction, at the end of CPB, before fluid administration and after fluid administration. Overall, median-IQR PRAM SVI values (23 ml·m(-2), 19-27) were significantly higher than bioreactance SVI (15 ml·m(-2), 12-25, P = 0.0001). Correlation (r(2) ) between the two methods was 0.15 (P = 0.0003). The mean difference between the measurements (bias) was 5.7 ml·m(-2) with a standard deviation of 9.6 (95% limits of agreement ranged from -13 to 24 ml·m(-2)). Percentage error was 91.7%. Baseline SVI appeared to be similar, but PRAM SVI was systematically greater than bioreactance thereafter, with the highest gap after the fluid loading phase: 13 (12-18) ml·m(-2) vs. 23 (19-25) ml·m(-2), respectively, P = 0.0013. A multivariable regression model showed that a significant independent inverse correlation with patients' body weight predicted the CI difference between the two methods after fluid challenge (β coefficient -0.12, P = 0.013). CONCLUSIONS Pressure recording analytical method and bioreactance provided similar SVI estimation at stable hemodynamic conditions, while bioreactance SVI values appeared significantly lower than PRAM at the end of CPB and after fluid replacement.
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Affiliation(s)
- Cristiana Garisto
- Pediatric Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Frank LH, Chelliah A, Sable CA. Evaluation of a Second-Generation Microtransesophageal Echocardiography Transducer and Software. World J Pediatr Congenit Heart Surg 2014; 5:565-70. [DOI: 10.1177/2150135114542167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Transesophageal echocardiographic imaging of small infants has been limited because of equipment size. A newer miniaturized transducer has allowed for the imaging of even the smallest patients but has been limited by intermittent poor image quality because of hardware durability. A second generation of the transducer was developed to address this problem. The aim of this study was to evaluate the performance and durability of the second-generation transducer over multiple uses and to compare the image quality from the modified transducer and new software preset to the original transducer. Methods: Patients undergoing transesophageal echocardiography (TEE) based on clinical indications with the original or second-generation transducers were included in the study. All studies were reviewed for image quality and unacceptable image degradation, which was defined as imaging quality inadequate for clinical use. Study review was performed by two echocardiographers. Results: Using the original transducer, 37 studies were performed with a mean patient weight of 3.46 ± 0.89 kg (range 2.1-5.7). Using the second-generation transducer, 65 studies were performed with a mean patient weight of 4.87 ± 2.05 kg (range 2.2-13.8). Image quality was clinically inadequate in 8 of the 35 studies with the original transducer and in zero with the second generation ( P < .0001). Conclusions: The second-generation transducer allows for effective use of TEE even in the smallest infants and avoids the mechanical failures associated with the first-generation release.
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Affiliation(s)
- Lowell H. Frank
- Division of Cardiology, Children’s National Medical Center, Washington, DC, USA
| | - Anjali Chelliah
- Division of Pediatric Cardiology, Morgan Stanley Children’s Hospital, New York Presbyterian – Columbia University Medical Center, New York, NY, USA
| | - Craig A. Sable
- Division of Cardiology, Children’s National Medical Center, Washington, DC, USA
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Porciello F, Caivano D, Giorgi ME, Knafelz P, Rishniw M, Moise NS, Bufalari A, Fruganti A, Birettoni F. Transesophageal echocardiography as the sole guidance for occlusion of patent ductus arteriosus using a canine ductal occluder in dogs. J Vet Intern Med 2014; 28:1504-12. [PMID: 25041218 PMCID: PMC4895578 DOI: 10.1111/jvim.12401] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 04/14/2014] [Accepted: 05/29/2014] [Indexed: 11/29/2022] Open
Abstract
Background Transcatheter occlusion of patent ductus arteriosus (PDA) is usually performed by fluoroscopy alone or together with transesophageal echocardiography (TEE). Transthoracic echocardiography (TTE) guidance has been used for deployment of Amplatz Canine Ductal Occluder (ACDO), but sometimes is limited by suboptimal acoustic windows. Transesophageal echocardiography can overcome such issues and provides higher image resolution at the level of the great vessels. Objectives To determine if TEE without fluoroscopy could be used to successfully perform ductal occlusion for the treatment of PDA in dogs. Animals Twenty client‐owned dogs with PDA. Methods A prospective consecutive case series of PDA occlusion was performed using only TEE guidance. Dogs were positioned in right lateral recumbency and the TEE probe was positioned to visualize the descending aorta, PDA, and pulmonary artery. The guide wire, long introducer sheath, and ACDO were imaged by TEE to direct deployment. Results Ductal occlusion was performed successfully without need for fluoroscopy and without complications in 19 dogs. One dog required a second larger ACDO because of embolization of the first device 18 hours after positioning. Conclusions and Clinical Importance We have demonstrated that TEE monitoring without concurrent fluoroscopy can guide each step of transcatheter ACDO embolization thereby providing an alternate method of visualization for this procedure. Use of TEE alone can reduce radiation exposure or is an option when fluoroscopy is not available, and, therefore, should be evaluated in a larger case series to better assess procedural failure rates.
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Affiliation(s)
- F Porciello
- Department of Veterinary Medicine, University of Perugia, Perugia, Italy
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Hascoët S, Peyre M, Hadeed K, Alacoque X, Chausseray G, Fesseau R, Amadieu R, Léobon B, Berthomieu L, Dulac Y, Acar P. Safety and efficiency of the new micro-multiplane transoesophageal probe in paediatric cardiology. Arch Cardiovasc Dis 2014; 107:361-70. [DOI: 10.1016/j.acvd.2014.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 04/28/2014] [Accepted: 05/06/2014] [Indexed: 11/28/2022]
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Using technology to find the secret places of the heart. Vet J 2014; 200:216-7. [DOI: 10.1016/j.tvjl.2014.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/18/2014] [Accepted: 02/20/2014] [Indexed: 11/19/2022]
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Prêtre R. Subaortic ventricular septal defect closure: is the principle of harmony for a longer function no longer valid? Eur J Cardiothorac Surg 2014; 46:654-5. [PMID: 24652815 DOI: 10.1093/ejcts/ezu125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- René Prêtre
- Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland
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Innovative transesophageal echocardiography training and competency assessment for Chinese anesthesiologists: role of transesophageal echocardiography simulation training. Curr Opin Anaesthesiol 2013; 25:686-91. [PMID: 23079579 DOI: 10.1097/aco.0b013e32835a10fb] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE OF REVIEW Transesophageal echocardiography (TEE) is playing an invaluable role in diagnosing and monitoring the patient's hemodynamics in both cardiac and noncardiac surgery. There have been many obstacles in TEE training. RECENT FINDINGS The TEE simulation provides an ideal environment for anesthesiologists to practice their echocardiography skills out of the operation room. It consists of a manikin and a dummy probe that enable the trainees to perform a hands-on operation with echocardiographic views and allow a virtual scene consisting of a three-dimensional cardiac model, probe tip and image plane be presented side by side simultaneously. SUMMARY The TEE simulator provides an easy comprehensive learning interface and a friendly environment without the psychological pressure and time limitation frequently experienced in the operation room. The simulator can also be used to assess and evaluate the trainees' manipulation skills, space thinking, and clinical judgment ability. TEE simulation-based training and testing can be an important part in TEE training curriculum before the trainees start their clinical training in the operation room.
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Abstract
Transesophageal echocardiography (TEE) plays an important role in the anatomical, functional, and hemodynamic assessment of patients with congenital heart disease (CHD). This imaging approach has been applied to both children and adults with a wide range of cardiovascular malformations. Extensive clinical experience documents significant contributions, particularly in the perioperative setting. In fact, in the current medical era, many consider this technology to be an essential adjunct to surgical and anesthetic management in CHD. This review focuses on the applications of TEE in patients with tetralogy of Fallot (TOF), the most common form of cyanotic heart disease. Emphasis is given to the perioperative use of this imaging modality and benefits derived during the prebypass and postbypass periods. Limitations and pitfalls relevant to the TEE assessment in patients with this anomaly are also addressed.
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