1
|
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: 8] [Impact Index Per Article: 1.3] [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.
Collapse
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..
| |
Collapse
|
2
|
Dursun M, Yılmaz S, Yılmaz E, Yılmaz R, Onur İ, Oflaz H, Dindar A. The utility of cardiac MRI in diagnosis of infective endocarditis: preliminary results. Diagn Interv Radiol 2016; 21:28-33. [PMID: 25430531 DOI: 10.5152/dir.2014.14239] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE We aimed to evaluate the utility of cardiac magnetic resonance imaging (MRI) for the diagnosis of infective endocarditis (IE). METHODS Sixteen patients with a preliminary diagnosis of IE (10 women and six men; age range, 4-66 years) were referred for cardiac MRI. MRI sequences were as follows: echo-planar cine true fast imaging with steady-state precession (true-FISP), dark-blood fast spin echo T1-weighted imaging, T2-weighted imaging, dark-blood half-Fourier single shot turbo spin echo (HASTE), and early contrast-enhanced first-pass fast low-angle shot (FLASH). Delayed contrast-enhanced images were obtained using three-dimensional inversion recovery FLASH after 15±5 min. The MRI features were evaluated, including valvular pathologies on cine MRI and contrast enhancement on the walls of the cardiac chambers, major thoracic vasculature, and paravalvular tissue, attributable to endothelial extension of inflammation on contrast-enhanced images. RESULTS Fourteen valvular vegetations were detected in eleven patients on cardiac MRI. It was not possible to depict valvular vegetations in five patients. Vegetations were detected on the aortic valve (n=7), mitral valve (n=3), tricuspid and pulmonary valves (n=1). Delayed contrast enhancement attributable to extension of inflammation was observed on the aortic wall and aortic root (n=11), paravalvular tissue (n=4), mitral valve (n=2), walls of the cardiac chambers (n=6), interventricular septum (n=3), and wall of the pulmonary artery and superior mesenteric artery (n=1). CONCLUSION Valvular vegetation features of IE can be detected by MRI. Moreover, in the absence of vegetations, detection of delayed enhancement representing endothelial inflammation of the cardiovascular structures can contribute to the diagnosis and treatment planning of IE.
Collapse
Affiliation(s)
- Memduh Dursun
- Department of Radiology, Istanbul University, Istanbul School of Medicine, Istanbul, Turkey.
| | | | | | | | | | | | | |
Collapse
|
3
|
Patel JK, Glatz AC, Ghosh RM, Jones SM, Ravishankar C, Mascio C, Cohen MS. Accuracy of transesophageal echocardiography in the identification of postoperative intramural ventricular septal defects. J Thorac Cardiovasc Surg 2016; 152:688-95. [PMID: 27183884 DOI: 10.1016/j.jtcvs.2016.04.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 03/18/2016] [Accepted: 04/01/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intramural ventricular septal defects (VSDs), residual interventricular communications occurring after repair of conotruncal defects, are associated with poor postoperative outcomes. The ability of intraoperative transesophageal echocardiography (TEE) to identify intramural VSDs has not yet been evaluated. METHODS Intraoperative TEE and postoperative transthoracic echocardiography (TTE) data in all patients undergoing all biventricular repair of conotruncal anomalies in our hospital between January 1, 2006, and June 30, 2013, were reviewed. The ability of TEE to accurately identify residual defects was assessed using postoperative TTE as the reference imaging modality. RESULTS Intramural VSDs occurred in 34 of 337 patients evaluated; 19 were identified by both TTE and TEE, and 15 were identified by TTE only. Sensitivity was 56% and specificity was 100% for TEE to identify intramural VSDs. Peripatch VSDs were identified in 90 patients by both TTE and TEE, in 53 by TTE only, and in 15 by TEE only, yielding a sensitivity of 63% and specificity of 92%. Of the VSDs requiring catheterization or surgical reintervention, 6 of 7 intramural VSDs and all 5 peripatch VSDs were identified by intraoperative TEE. TEE guided the intraoperative decision to return to cardiopulmonary bypass (CPB) in an attempt to close residual defects in 12 patients with intramural VSDs and in 4 patients with peripatch VSDs seen after initial CPB; of these, 10 intramural VSDs and all 4 peripatch VSDs resolved or became smaller on final intraoperative TEE. CONCLUSIONS TEE has modest sensitivity but high specificity for identifying intramural VSDs and can detect most defects requiring reintervention. Repeat attempts at closure in the index operation may successfully correct intramural VSDs identified by TEE.
Collapse
Affiliation(s)
- Jyoti K Patel
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Andrew C Glatz
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Reena M Ghosh
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Shannon M Jones
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Chitra Ravishankar
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Christopher Mascio
- Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Meryl S Cohen
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pa.
| |
Collapse
|
4
|
Jijeh AM, Omran AS, Najm HK, Abu-Sulaiman RM. Role of intraoperative transesophageal echocardiography in pediatric cardiac surgery. J Saudi Heart Assoc 2016; 28:89-94. [PMID: 27053898 PMCID: PMC4803757 DOI: 10.1016/j.jsha.2015.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 06/04/2015] [Accepted: 06/17/2015] [Indexed: 11/25/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Abdulraouf M.Z. Jijeh
- King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Riyadh, Saudi Arabia
| | - Ahmad S. Omran
- King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hani K. Najm
- King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Riyadh M. Abu-Sulaiman
- King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| |
Collapse
|
5
|
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]
|
6
|
Ferns S, Komarlu R, Van Bergen A, Multani K, Cui VW, Roberson DA. Transesophageal echocardiography in critically ill acute postoperative infants: comparison of AcuNav intracardiac echocardiographic and microTEE miniaturized transducers. J Am Soc Echocardiogr 2012; 25:874-81. [PMID: 22749435 DOI: 10.1016/j.echo.2012.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multiple barriers to transthoracic echocardiography are present in critically ill infants immediately after surgery. Transesophageal echocardiography (TEE) is sometimes needed to obtain specific important information that transthoracic echocardiography fails to demonstrate. Formerly, the investigators used the AcuNav intracardiac echocardiographic (ICE) intravascular ultrasound transducer (8 Fr, 2.5 mm, 64-element crystal array, multifrequency [5.5-10 MHz], single longitudinal plane, linear phased array [Siemens Medical Solutions USA, Inc., Mountain View, CA]). Recently, the investigators have also used the microTEE transducer (8-mm transducer tip, 5.2-mm shaft, multifrequency [3-8 MHz], multiplane phased array, 32-element probe [Philips Medical Systems, Andover, MA]). Both transducers have two-dimensional, M-mode, color Doppler, and pulsed-wave and continuous-wave Doppler capabilities. The aim of this study was to compare the efficacy, safety, ease of insertion, capabilities, utilization, and cost of the AcuNav ICE transducer versus those of the microTEE transducer. METHODS A retrospective review of all 50 postoperative critically ill infants who underwent TEE using the AcuNav and microTEE in the past 5 years was conducted. TEE was performed as ordered by the attending physician to answer a specific question not answered by transthoracic echocardiography. RESULTS In all cases, the clinical information sought was obtained. The AcuNav ICE transducer was safe, easy to insert through the transnasal route, and did not require paralysis; however, it had a limited number of echocardiographic views and had greater sterilization cost. The microTEE transducer had greater echocardiographic capabilities and lower sterilization cost; however, it was slightly more difficult to insert, had a few manageable complications, and required more sedation and paralysis. CONCLUSIONS TEE in this setting has increased because of demonstrated efficacy and safety. Both the AcuNav ICE and microTEE transducers are useful and effective in this critical clinical scenario.
Collapse
Affiliation(s)
- Sunita Ferns
- Heart Institute for Children, Hope Children's Hospital, Chicago Medical School, Oak Lawn, Illinois 60453, USA
| | | | | | | | | | | |
Collapse
|
7
|
Kurokawa S, Taneoka M, Imai H, Baba H, Nomura M. Transesophageal echocardiography detection of undiagnosed multiple muscular ventricular septal defects with alteration of shunt flow by right ventricular pacing after an arterial switch operation in a neonate. Anesth Analg 2011; 113:233-5. [PMID: 21596880 DOI: 10.1213/ane.0b013e31821e9765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Satoshi Kurokawa
- Tokyo Women's Medical University, Faculty of Medicine, Department of Anesthesiology, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan 162-8666.
| | | | | | | | | |
Collapse
|
8
|
Kurokawa S, Honma T, Taneoka M, Imai H, Baba H, Nomura M. Can intraoperative TEE correctly measure residual shunt after surgical repair of ventricular septal defects? J Anesth 2010; 24:343-50. [PMID: 20229003 DOI: 10.1007/s00540-010-0896-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 01/03/2010] [Indexed: 11/24/2022]
Abstract
PURPOSE No groups have yet succeeded in identifying the need for re-repair of residual shunt after surgical repair of ventricular septal defect (VSD) based on quantitative evaluation of the ratio of the pulmonary blood flow to the systemic blood flow (Qp/Qs) by transesophageal echocardiography (TEE). Hence, we studied the accuracy of Qp/Qs as estimated by intraoperative TEE. METHODS Twenty-six patients undergoing VSD closure were studied. After separation from the cardiopulmonary bypass, the presence and severity of residual leakage was evaluated by color Doppler image, and the Qp/Qs (TEE-derived Qp/Qs) was calculated by measuring the vessel diameter and the velocity-time integral of the flow profiles in the main pulmonary artery and left ventricular outflow tract. Transthoracic echocardiography (TTE) was performed at pre-discharge and at 6-12 months after the correction to confirm the presence and severity of residual leakage. RESULTS TEE detected only minor leakage, with no indication for re-repair, in 8 of the 26 patients. Nevertheless, TEE-derived Qp/Qs varied from 0.57 to 2.07 and were incorrect in 17 patients (65.4%). This meant that when TEE-derived Qp/Qs was outside the acceptable range, the patient was judged not to be in need of re-repair. TTE at pre-discharge confirmed trivial leakage in 3 patients in whom TEE had also identified similar leakages. These leakages were not observed at the follow-up TTE. CONCLUSION TEE-derived Qp/Qs lacks the accuracy required to play a crucial role in quantitatively measuring the severity of residual shunt, while two-dimensional TEE can reliably detect residual leakage after VSD closure and lead to optimal judgment on the need for re-repair.
Collapse
Affiliation(s)
- Satoshi Kurokawa
- Department of Anesthesiology, Faculty of Medicine, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162-8666, Japan.
| | | | | | | | | | | |
Collapse
|
9
|
Marino BS, Pasquali SK, Wernovsky G, Pudusseri A, Rychik J, Montenegro L, Shera D, Spray TL, Cohen MS. Accuracy of intraoperative transesophageal echocardiography in the prediction of future neo-aortic valve function after the Ross procedure in children and young adults. CONGENIT HEART DIS 2008; 3:39-46. [PMID: 18373748 DOI: 10.1111/j.1747-0803.2007.00156.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Neo-aortic insufficiency (neo-AI) has been noted following the Ross procedure. The purpose of this study was to evaluate the ability of intraoperative transesophageal echocardiography (TEE) to predict future neo-AI in pediatric patients undergoing the Ross from January 1995 to December 2003, who had an intraoperative TEE, and discharge and follow-up transthoracic (TTE) echocardiograms. DESIGN Retrospective case series. PATIENTS All patients who underwent the Ross procedure at Children's Hospital of Philadephia between January 1995 and December 2003, and had an intraoperative TEE, discharge, and follow-up (>6 months) transthoracic echocardiogram (TTE) (by July 1, 2004) were included. OUTCOME MEASURES Grade of neo-AI was assessed on intraoperative TEE, discharge, and follow-up TTE echocardiogram reports. RESULTS Follow-up was available in 99/115 (86%) survivors. Median age at Ross was 9.3 years (4 days-34 years). No patient had more than mild neo-AI on intraoperative TEE. At discharge, 2 patients (2%) had moderate neo-AI. At most recent follow-up (median 4.2 years, 8 months-9.3 years), 21 patients (21%) had moderate or greater neo-AI; 9 underwent neo-aortic reintervention. The presence of any neo-AI on intraoperative TEE had 100% sensitivity and negative predictive value for diagnosing moderate or greater neo-AI at discharge. Patients who had mild neo-AI on TEE were more likely to have moderate or greater neo-AI at most recent follow-up than those patients with no neo-AI on TEE (9% vs. 30%, P = 0.01). CONCLUSION Intraoperative TEE is an excellent screening tool for the presence of significant neo-AI at the time of hospital discharge. Neo-AI progresses over time after Ross procedure and is more likely to progress in those patients with neo-AI on intraoperative TEE. However, predictive validity decreases over time as neo-AI progresses.
Collapse
Affiliation(s)
- Bradley S Marino
- Children's Hospital of Philadelphia, Pediatrics Divisions of Cardiology, Philadelphia, PA, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Neema PK, Manikandan S, Vijayakumar A, Misra S, Rathod RC. Resolution of airway compression induced by transesophageal echocardiography probe insertion in a pediatric patient after repair of an atrial septal defect and partial anomalous pulmonary venous connection. J Cardiothorac Vasc Anesth 2007; 22:887-9. [PMID: 18834759 DOI: 10.1053/j.jvca.2007.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Indexed: 11/11/2022]
Affiliation(s)
- Praveen Kumar Neema
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, India.
| | | | | | | | | |
Collapse
|
11
|
Cohen GA, Stevenson JG. Intraoperative echocardiography for atrioventricular canal: decision-making for surgeons. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2007:47-50. [PMID: 17433991 DOI: 10.1053/j.pcsu.2007.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Intraoperative echocardiography has become a standard patient management tool in the assessment of the patient undergoing surgical repair of a congenital cardiac defect. Over the past 15 years transesophageal echocardiography has emerged as an integral part of the intraoperative assessment of the congenital cardiac surgery patient. The important role of intraoperative echocardiography is largely because of its ability to define complex anatomy, identify functional abnormalities, and recognize flow disturbances at the time of surgical repair. Intracardiac defects are particularly suited to the strengths of intraoperative transesophageal echocardiography because of the unobstructed windows that can be obtained. This article focuses on how intraoperative echocardiography can guide surgical decision-making in the patient undergoing repair of an atrioventricular canal defect.
Collapse
Affiliation(s)
- Gordon A Cohen
- Division of Pediatric Cardiology, Department of Pediatric Cardiothoracic Surgery, Children's Heart Center, Children's Hospital and Regional Medical Center, Seattle 98105, WA, USA.
| | | |
Collapse
|
12
|
Intraoperative echocardiography in children. COR ET VASA 2006. [DOI: 10.33678/cor.2006.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
13
|
Dursun M, Yilmaz S, Ali Sayin O, Olgar S, Dursun F, Yekeler E, Tunaci A. A rare cause of delayed contrast enhancement on cardiac magnetic resonance imaging: infective endocarditis. J Comput Assist Tomogr 2005; 29:709-11. [PMID: 16163048 DOI: 10.1097/01.rct.0000177520.02175.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although there have been a few reports about the magnetic resonance (MR) imaging features of infective endocarditis (IE), delayed contrast enhancement attributable to fibrosis has not been previously described. The case of a 4-year-old girl who was diagnosed with IE based on positive blood culture results and echocardiographic findings is presented. At cardiac MR imaging, late phase contrast-enhanced images revealed a significant enhancement suggesting fibrosis secondary to IE.
Collapse
Affiliation(s)
- Memduh Dursun
- Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, Turkey.
| | | | | | | | | | | | | |
Collapse
|
14
|
Bettex DA, Schmidlin D, Bernath MA, Prêtre R, Hurni M, Jenni R, Chassot PG, Schmid ER. Intraoperative Transesophageal Echocardiography in Pediatric Congenital Cardiac Surgery: A Two-Center Observational Study. Anesth Analg 2003; 97:1275-1282. [PMID: 14570637 DOI: 10.1213/01.ane.0000081794.31004.18] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED Transesophageal echocardiography (TEE) is a monitoring and diagnostic tool for the care of children undergoing cardiac surgery. We analyzed reports from 865 routine TEE examinations performed between January 1994 and March 2002 in patients younger than 17-yr-old who were undergoing surgery for congenital heart disease. Patients' median age was 36 mo (range, 1 day-16 yr). The primary end-point of the study was the incidence of surgical and medical management decisions changed as a result of TEE findings; secondary end-points were diagnostic impact (diagnostic exclusions and new diagnoses) and surgical outcome. Fifty percent of the examinations were performed by anesthesiologists with an advanced level of training in perioperative TEE; all of the examiners had an experience of >or=>500 TEE examinations. Supervision by an anesthesiologist with an advanced level of training was requested in 36.7% of cases; supervision by a cardiologist was requested in 3.8%. Surgical alterations of management were reported in 12.7% of cases and included the need for a repeat bypass run in 7.3%; medical alterations of management were required in 19.4% of cases. We observed a diagnostic impact of TEE in 18.5% of cases and a suboptimal but acceptable surgical outcome in 27.6%; TEE findings predicted postoperative difficulties in 4.0%. Our results confirm the utility of routine TEE to assess repair of congenital heart defects. Furthermore, this service was competently performed by a regular team of cardiac anesthesiologists appropriately trained in TEE. IMPLICATIONS Transesophageal echocardiography (TEE) is an essential monitoring and diagnostic device for the care of children undergoing cardiac surgery. The surgical and medical impact of TEE is demonstrated in a large series of patients. This service can be performed by appropriately trained cardiac anesthesiologists.
Collapse
Affiliation(s)
- Dominique A Bettex
- *Division of Cardiovascular Anesthesia, University Hospital of Zurich, Switzerland; †Department of Anesthesia, University Hospital of Lausanne, Switzerland; ‡Department of Cardiovascular Surgery, University Hospital of Zurich, Switzerland; §Department of Cardiovascular Surgery, University Hospital of Lausanne, Switzerland; ∥Department of Cardiology, University Hospital of Zurich, Switzerland
| | | | | | | | | | | | | | | |
Collapse
|
15
|
ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: Summary Article. J Am Soc Echocardiogr 2003. [DOI: 10.1016/j.echo.2003.08.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
16
|
Cheitlin MD, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davis JL, Douglas PS, Faxon DP, Gillam LD, Kimball TR, Kussmaul WG, Pearlman AS, Philbrick JT, Rakowski H, Thys DM. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). J Am Coll Cardiol 2003; 42:954-70. [PMID: 12957449 DOI: 10.1016/s0735-1097(03)01065-9] [Citation(s) in RCA: 341] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
17
|
Cheitlin MD, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davis JL, Douglas PS, Faxon DP, Gillam LD, Kimball TR, Kussmaul WG, Pearlman AS, Philbrick JT, Rakowski H, Thys DM, Antman EM, Smith SC, Alpert JS, Gregoratos G, Anderson JL, Hiratzka LF, Hunt SA, Fuster V, Jacobs AK, Gibbons RJ, Russell RO. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). Circulation 2003; 108:1146-62. [PMID: 12952829 DOI: 10.1161/01.cir.0000073597.57414.a9] [Citation(s) in RCA: 517] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
18
|
Koinig H, Schlemmer M, Keznickl FP. Occlusion of the right subclavian artery after insertion of a transoesophageal echocardiography probe in a neonate. Paediatr Anaesth 2003; 13:617-9. [PMID: 12950863 DOI: 10.1046/j.1460-9592.2003.00958.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present a case of occlusion of the right arm's blood supply in a neonate with a lusorian artery, a rare anomaly of the right subclavian artery, after insertion of a transoesophageal echocardiography (TOE) probe and discuss the impact of a lusorian artery on intraoperative TOE monitoring.
Collapse
Affiliation(s)
- Herbert Koinig
- Departments of Cardiothoracic Anaesthesia & Intensive Care Medicine, University of Vienna, Vienna, Austria.
| | | | | |
Collapse
|
19
|
Shiga T, Wajima Z, Inoue T, Ogawa R. Survey of observer variation in transesophageal echocardiography: comparison of anesthesiology and cardiology literature. J Cardiothorac Vasc Anesth 2003; 17:430-42. [PMID: 12968229 DOI: 10.1016/s1053-0770(03)00146-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Transesophageal echocardiographic examination tends to be somewhat observer and experience dependent, and observer bias can arise easily when data are calculated and interpreted by unskilled, nonblinded, or single observers. The study plan was to see whether authors have adequately described how observer bias is minimized in their studies. Thus, a study was conducted systematically reviewing methods reported in transesophageal echocardio graphy articles in peer-reviewed anesthesiology journals versus those reported in peer-reviewed cardiology journals. INTERVENTIONS After MEDLINE searches of the literature published from 1997 through 1999, the authors investigated 56 anesthesiology reports and 56 randomly selected, year-matched cardiology reports. An 8-item questionnaire was developed that examined several factors: the number of observers and their experience levels, whether observers were blind to clinical data, whether low-quality images were excluded, the use of on-line or off-line analysis, and observer variability. MAIN RESULTS The analysis revealed inadequacies in reporting of important information that relates to bias and quality in 91.1% of anesthesiology and 98.2% of cardiology articles. Observer variability was not reported in 50.0% of the anesthesiology reports and 67.9% of the cardiology reports; however, difference between the 2 bodies of literature was not significant. The journal impact factor was significantly higher for the cardiology literature than for the anesthesiology literature (2.42 [0.386-10.893] v 1.07 [0.664-3.439]; median [range], p < 0.001). CONCLUSION Articles reviewed had at least some inadequacies in reporting the methods to minimize observer bias in both the anesthesiology and cardiology literature. Reporting methodology standards in TEE examinations remain to be established.
Collapse
Affiliation(s)
- Toshiya Shiga
- Department of Anesthesia, Chiba Hokusoh Hospital, Nipon Medical School, Chiba, Japan. shiga/
| | | | | | | |
Collapse
|
20
|
Humpl T, McCrindle BW, Smallhorn JF. The relative roles of transthoracic compared with transesophageal echocardiography in children with suspected infective endocarditis. J Am Coll Cardiol 2003; 41:2068-71. [PMID: 12798583 DOI: 10.1016/s0735-1097(03)00419-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The study evaluated the additional benefit of transesophageal echocardiography (TEE) versus transthoracic echocardiography (TTE) in pediatric cases with suspected bacterial endocarditis. BACKGROUND In adult patients, TTE has a lower sensitivity and specificity than TEE for the detection of vegetations or aortic root abscess formation. Few data are available about the relative benefits of TEE over TTE in the pediatric age group. METHODS Patients were included if they had positive blood cultures for typical microorganisms and had a TTE and TEE within 14 days of each other. The patients had to meet the Duke criteria for a positive diagnosis of bacterial endocarditis. The TTE and TEE data were analyzed using the McNemar test for the significance of change. RESULTS Twenty-one patients fulfilled the criteria, at a median age of 9.5 years. Congenital heart disease was present in 13 patients; 4 patients were previously healthy and 4 patients had other medical problems. Nine patients had surgical confirmation of bacterial endocarditis. Fifteen patients had a positive cardiac finding, with 12 vegetations, 2 vegetations plus aortic root abscess, and 1 isolated abscess. There was excellent agreement between TTE and TEE in those cases with positive cardiac findings, with a p = 0.32, kappa 0.89. Using positive TEE cardiac findings as the gold standard, the sensitivity for TTE was 86% for all 15 events and 93% for the detection of a vegetation. CONCLUSIONS In pediatric cases, TTE has a high degree of sensitivity for the detection of supportive evidence of endocarditis, and TEE should be reserved for patients with a poor transthoracic window.
Collapse
Affiliation(s)
- Tilman Humpl
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | | |
Collapse
|
21
|
Bruce CJ, O'Leary P, Hagler DJ, Seward JB, Cabalka AK. Miniaturized transesophageal echocardiography in newborn infants. J Am Soc Echocardiogr 2002; 15:791-7. [PMID: 12174348 DOI: 10.1067/mje.2002.120978] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND METHODS A miniaturized 5.5 to 10 MHz, phased-array, single longitudinal plane transducer mounted on a 3.3-mm diameter catheter (miniaturized transesophageal echocardiography [TEE]) may overcome mechanical limitations of standard pediatric transesophageal probes. We evaluated whether the miniaturized TEE probe could define clinically relevant anatomy in 17 infants who weighed less than 6 kg. RESULTS Twenty-two studies were performed in 17 infants without complication, weighing 2.1 to 5.6 kg. Twenty of twenty-two studies were diagnostic. Pediatric biplane TEE was not possible in 13 studies. Lack of horizontal plane imaging with miniaturized TEE made evaluation difficult in patients with atrioventricular septal defect. CONCLUSION Miniaturized TEE provided diagnostic intraoperative TEE in the majority of infants studied and may allow broader and safer application of TEE to neonates and small infants.
Collapse
Affiliation(s)
- Charles J Bruce
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Foundation, Rochester, MN 55905, USA
| | | | | | | | | |
Collapse
|
22
|
Sloth E, Pedersen J, Olsen KH, Wanscher M, Hansen OK, Sørensen KE. Transoesophageal echocardiographic monitoring during paediatric cardiac surgery: obtainable information and feasibility in 532 children. Paediatr Anaesth 2001; 11:657-62. [PMID: 11696140 DOI: 10.1046/j.1460-9592.2001.00737.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND We hypothesized that transoesophageal echocardiography (TOE) performed by the anaesthesiologists would be beneficial for monitoring purposes during paediatric cardiac surgery. We present the results for the first 5 years in 532 consecutive children. METHODS The probe was successfully inserted in 99% of cases and remained in the oesophagus for 211 min on average (range 10-555 min). RESULTS Insignificant valve leak, single- or biventricular failure and volume depletion were the most common new findings due to TOE. Changes in inotropic strategy and volume replacement were the most frequent interventions. In 45% of the cases, new information was disclosed and, in a total of 8% of cases, decisive information was provided. Except for tracheal extubation in one child who was uneventfully reintubated, no severe complications were identified. CONCLUSIONS These data stress the safety and ease of performing TOE in children undergoing cardiac surgery. There is evidence for benefit from TOE findings to potentially enhance the therapeutic basis.
Collapse
Affiliation(s)
- E Sloth
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Denmark.
| | | | | | | | | | | |
Collapse
|
23
|
Fagan S, Veinot JP, Chan KL. Residual sinus venosus atrial septal defect after surgical closure of atrial septal defect. J Am Soc Echocardiogr 2001; 14:738-41. [PMID: 11447421 DOI: 10.1067/mje.2001.111005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We describe residual atrial septal defects in 3 patients who had previous surgical repair. The residual defects were the sinus venosus type near the orifice of the inferior vena cava. Preoperative and intraoperative transesophageal echocardiography may aid in the detection and facilitate the successful repair of these defects.
Collapse
Affiliation(s)
- S Fagan
- University of Ottawa Heart Institute, Ontario, Canada
| | | | | |
Collapse
|
24
|
Haas GS. Advances in pediatric cardiovascular surgery: anatomic reconstruction of the left ventricular outflow tract in transposition of the great arteries with pulmonic valve abnormalities. Curr Opin Pediatr 2000; 12:501-4. [PMID: 11021418 DOI: 10.1097/00008480-200010000-00016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the past years, advances in pediatric cardiovascular surgery have occurred in many areas with some of the greatest strides being made in complex repairs in younger age groups. Aggressive early corrections while higher risk, may in the long run provide a child with a normal anatomic heart, and corresponding myocardial growth and physiology.
Collapse
Affiliation(s)
- G S Haas
- Pediatric Cardiac Surgery, Tampa Children's Hospital, Florida 33607, USA
| |
Collapse
|