The Usefulness of Transesophageal Echocardiography in the Surgical Management of Older Children with Subaortic Stenosis

Intraoperative transesophageal echocardiography during surgery for congenital heart defects

OBJECTIVE

This study was undertaken to further define the impact of intraoperative transesophageal echocardiography during surgery for congenital heart disease and to determine appropriate indications.

METHODS

The impact of transesophageal echocardiography on patient care was assessed in 1002 patients who underwent this procedure during surgery for congenital heart defects. It had major impact when new information altered the planned procedure or led to a revision of the initial repair. The safety of intraoperative transesophageal echocardiography was evaluated by review of the prospective data sheets and the medical record. A simple relative cost analysis was also performed.

RESULTS

Patient median age was 9.9 years (range 2 days to 85 years). Transesophageal echocardiography had prebypass or postbypass major impact in 13.8% of cases (n = 138/1002). Major impact was more frequent during reoperations (P <.03). Procedures that benefited most from the additional information were valve repairs (aortic or atrioventricular) and complex outflow tract reconstructions. Partial anomalous pulmonary venous connection, tricuspid valve repair (other than of Ebstein anomaly), simple atrioventricular discordance, aortic arch anomalies, and secundum atrial septal defects had major impact rates less than 5%. No major complications occurred. Minor complications occurred in 1% of patients and were most often observed in infants smaller than 4 kg. Routine use of transesophageal echocardiography for all patients with congenital heart defects proved cost-effective.

CONCLUSIONS

On the combined basis of the observed rates of major impact, the minimal complications, and the relative cost advantage, we believe that routine use of transesophageal echocardiography during most intracardiac repairs of congenital heart defects is justified, particularly for patients undergoing repeat operations for congenital cardiac malformations.

Multiplane Transesophageal Echocardiographic Evaluation of Defects of the Atrioventricular Septum: The Crux of the Matter

The availability of multiplane transesophageal probes has dramatically facilitated visualization of complex cardiac anatomy, with full dynamic tracking of anatomic contiguity. This report describes the unique applicability of multiplane transesophageal echocardiography (TEE) for visualization and assessment of a spectrum of congenital cardiac defects involving the cardiac crux, including the atrioventricular septum, inlet muscular septum, and the atrioventricular valves. With further evolution and progressive miniaturization of these probes, the use of this echocardiographic modality will hopefully encroach into the young infant age range, permitting enhanced preoperative and perioperative depiction of complex congenital cardiac anatomy. (ECHOCARDIOGRAPHY, Volume 13, November 1996)