1
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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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Lamond B, Roberts SD, Miller SP, Wade SL, Williams TS. Psychosocial Intervention Outcomes for Children with Congenital and Neonatal Conditions: Systematic Review. J Pediatr Psychol 2022; 47:1003-1018. [PMID: 35472174 DOI: 10.1093/jpepsy/jsac038] [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: 12/10/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/14/2022] Open
Abstract
There has been a historic lack of psychosocially geared treatment studies for congenital and neonatal conditions that impact brain development, despite well-established knowledge that these conditions impact cognitive development, quality of life (QoL), mental health, and academic success. OBJECTIVE The aim of the present study was to systematically investigate the research literature focusing on the effects of interventions in psychosocially geared programs for children with neonatal brain injury on school and psychological outcomes. METHODS Psychosocially geared programs broadly refer to interventions to improve parenting and school functioning, or child behavior, as well as other interventions that have a psychological component but may be more physically oriented, such as goal-directed physiotherapy. A comprehensive search of PubMed, Medline, PsychINFO, and Embase was completed between June and July 2020. The methodological quality of included articles was assessed using the Cochrane Risk of Bias Tool for Randomized Trials (RoB-2). RESULTS AND CONCLUSION Twenty studies met the inclusion criteria and demonstrated adequate risk of bias (i.e., low risk of bias or some concerns). The studies included family (n = 2), parenting (n = 7), and child (n = 10) interventions. There is some evidence supporting the effectiveness of psychosocial interventions for children with neonatal brain injury and their families on academic outcomes, behavior, and QoL, indicated by positive intervention effects in 65% (n = 13) of studies.
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Affiliation(s)
- Bronwyn Lamond
- Department of Psychology, Division of Neurology, The Hospital for Sick Children, Canada.,Department of Applied Psychology and Human Development, The University of Toronto, Canada
| | - Samantha D Roberts
- Department of Psychology, Division of Neurology, The Hospital for Sick Children, Canada.,Department of Psychology, York University, Canada
| | - Steven P Miller
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Canada.,BC Children's Hospital & Sunny Hill Health Centre, Canada
| | - Shari L Wade
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Tricia S Williams
- Department of Psychology, Division of Neurology, The Hospital for Sick Children, Canada.,Department of Pediatrics, The University of Toronto, Canada
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3
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Pillai MN, Suneel PR, Menon S, Unnikrishnan KP, Baruah SD, Mathew T, Lovhale SP, Dharan BS. Intraoperative Three-dimensional Imaging of Ventricular Septal Defects in Children Using Epicardial Echocardiography: A Novel Approach. J Cardiothorac Vasc Anesth 2021; 35:2892-2899. [DOI: 10.1053/j.jvca.2020.10.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 11/11/2022]
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Devarakonda BV, Nemani DN, Raja J, Dharan BS, Koshy T. Role of Transesophageal and Epicardial Echocardiography to Assess Surgical Repair in Double-Outlet Left Ventricle. J Cardiothorac Vasc Anesth 2021; 36:1396-1400. [PMID: 33896712 DOI: 10.1053/j.jvca.2021.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/04/2021] [Accepted: 03/19/2021] [Indexed: 11/11/2022]
Abstract
A double-outlet left ventricle (DOLV) is a congenital cardiac anomaly that rarely is encountered. This case report demonstrates the echocardiographic features of DOLV in the form of the pulmonary artery arising completely from the left ventricle with D-looped ventricles, especially when evaluated by intraoperative transesophageal echocardiography (TEE), along with the correlation of characteristic features with cardiac computerized tomography. The features pertinent to the differentiation of DOLV from double-outlet right ventricle and congenitally corrected transposition of the great arteries by echocardiography have been described. To the authors' knowledge, this was the first report of intraoperative TEE in the case of DOLV. In addition, the use of intraoperative echocardiography to rule out coronary compression as a cause for post-repair ventricular tachycardia, by use of TEE to rule out ventricular dysfunction and regional wall motion abnormalities, as well as epicardial echocardiography to demonstrate normal coronary blood flow, has been reported.
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Affiliation(s)
- Bhargava V Devarakonda
- Department Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India.
| | - Dr Nayana Nemani
- Department Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India
| | - Javid Raja
- Department of Cardiothoracic & Vascular Surgery, Sri Manakkula Vinayakar Medical College & Hospital, Pondicherry, India
| | - Baiju S Dharan
- Department of Cardiovascular & Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India
| | - Thomas Koshy
- Department Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India
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5
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Veronese L, Swanevelder J, Brooks A. Anaesthesia for the child with a univentricular heart: a practical approach. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2021. [DOI: 10.36303/sajaa.2021.27.3.2572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - J Swanevelder
- Red Cross War Memorial Children’s Hospital, University of Cape Town,
South Africa
| | - A Brooks
- Red Cross War Memorial Children’s Hospital, University of Cape Town,
South Africa
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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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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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Mid-term Outcomes of Common Congenital Heart Defects Corrected Through a Right Subaxillary Thoracotomy. Heart Lung Circ 2017; 26:376-382. [DOI: 10.1016/j.hlc.2015.05.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 05/06/2015] [Accepted: 05/07/2015] [Indexed: 11/17/2022]
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9
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Stern KWD, Gauvreau K, Emani S, Geva T. Utility of a standardized postcardiopulmonary bypass epicardial echocardiography protocol for stage I Norwood palliation. CONGENIT HEART DIS 2017; 12:350-356. [PMID: 28205344 DOI: 10.1111/chd.12450] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/02/2016] [Accepted: 01/09/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Stage 1 Norwood palliation is one of the highest risk procedures in congenital cardiac surgery. Patients with superior technical performance scores have more favorable outcomes. Intraoperative epicardial echocardiography may allow the surgeon to address residual lesions prior to leaving the operating room, resulting in improved technical performance. The ability of intraoperative epicardial echocardiography to visualize the relevant anatomy and its association with outcomes is not known. DESIGN A standardized intraoperative epicardial echocardiography protocol was developed and performed at the conclusion of Stage 1 Norwood palliation. Data pertaining to visualization of relevant anatomy, and comparison of intraoperative echocardiogram findings with other postoperative investigations was performed. Clinical outcomes, including technical performance, were collected. A historical cohort who received either no echocardiogram or a nonstandardized examination was used as a comparison group. RESULTS Thirty on-protocol and 30 preprotocol patients, 22 of whom had a nonstandardized intraoperative epicardial echocardiogram, were studied. Compared with preprotocol, visualization of the relevant anatomy was significantly increased for the Damus-Kaye-Stansel anastomosis (93% vs. 68% P = .03) and branch pulmonary arteries (70% vs. 36%, P = .02). One residual lesion requiring immediate operative reintervention was diagnosed in the preprotocol group. There were 5 patients in each cohort with residual lesions during the postoperative hospitalization that were not appreciated on the intraoperative echocardiogram. Technical performance, rates of reintervention and clinical outcomes were not significantly different between the two groups. CONCLUSIONS Intraoperative epicardial echocardiography is technically feasible and increases visualization of the relevant anatomy. Larger investigations may be warranted to determine if there is clinical benefit to such an approach.
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Affiliation(s)
- Kenan W D Stern
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Sitaram Emani
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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10
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Rizza A, Bignami E, Belletti A, Polito A, Ricci Z, Isgrò G, Locatelli A, Cogo P. Vasoactive Drugs and Hemodynamic Monitoring in Pediatric Cardiac Intensive Care: An Italian Survey. World J Pediatr Congenit Heart Surg 2016; 7:25-31. [PMID: 26714990 DOI: 10.1177/2150135115606626] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Little is known about practitioner preference, the availability of technology, and variability in practice with respect to hemodynamic monitoring and vasoactive drug use after congenital heart surgery. The aim of this study was to characterize current hospital practices related to the management of low cardiac output syndrome (LCOS) across Italy. METHODS We issued a 22-item questionnaire to 14 Italian hospitals performing pediatric cardiac surgery. RESULTS Electrocardiogram, invasive blood pressure, central venous pressure, pulse oximetry, diuresis, body temperature, arterial lactate, and blood gas analysis were identified as routine in hemodynamic monitoring. With regard to advanced hemodynamic monitoring, pulmonary arterial catheter and transpulmonary thermodilution were available in 43% of the centers, uncalibrated pulse contour methods in 29% of the centers, and transesophageal/transthoracic echocardiograms in all of the centers. Dopamine added to milrinone was the most frequent drug regimen for LCOS prevention after cardiopulmonary bypass. Overall, 86% of centers used milrinone alone as the initial treatment for LCOS with elevated systemic vascular resistances and levosimendan, the second preferred choice. In cases of LCOS with low vascular resistance, epinephrine was the first choice (10 centers), dopamine was the second choice (4 centers), followed by vasopressin and norepinephrine (3 centers). For treatment of LCOS with elevated pulmonary resistances, milrinone was the first choice (eight centers), followed by inhaled nitric oxide (five centers). CONCLUSIONS The survey shows that advanced hemodynamic monitoring is rarely performed. The most commonly used vasoactive drugs are milrinone, levosimendan, dopamine, epinephrine, vasopressin, and norepinephrine. Guidelines on the topic are warranted.
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Affiliation(s)
- Alessandra Rizza
- Pediatric Cardiac Anesthesia/Intensive Care Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Elena Bignami
- Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy
| | - Angelo Polito
- Pediatric Cardiac Anesthesia/Intensive Care Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Zaccaria Ricci
- Pediatric Cardiac Anesthesia/Intensive Care Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giuseppe Isgrò
- Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese (Milan), Italy
| | | | - Paola Cogo
- Pediatric Cardiac Anesthesia/Intensive Care Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
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11
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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.
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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
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12
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Abstract
OBJECTIVES Trans-oesophageal echocardiographic imaging is valuable in the pre- and post-operative evaluation of children and adults with CHD; however, the frequency by which trans-oesophageal echocardiography guides the intra-operative course of patients is unknown. METHODS We retrospectively reviewed 1748 intra-operative trans-oesophageal echocardiograms performed between 1 October, 2005 and 31 December, 2010, and found 99 cases (5.7%) that required return to bypass, based in part upon the intra-operative echocardiographic findings. RESULTS The diagnoses most commonly requiring further repair and subsequent imaging were mitral valve disease (20.9%), tricuspid valve disease (16.0%), atrioventricular canal defects (12.0%), and pulmonary valve disease (14.1%). The vast majority of those requiring immediate return to bypass benefited by avoiding subsequent operations and longer lengths of hospital stay. A total of 14 patients (0.8%) who received routine imaging required further surgical repair within 1 week, usually due to disease that developed over ensuing days. Patients who had second post-operative trans-oesophageal echocardiograms in the operating room rarely required re-operations, confirming the benefit of routine intra-operative imaging. CONCLUSIONS This study represents a large single institutional review of intra-operative trans-oesophageal echocardiography, and confirms its applicability in the surgical repair of patients with CHD. Routine imaging accurately identifies patients requiring further intervention, does not confer additional risk of mortality or prolonged length of hospital stay, and prevents subsequent operations and associated sequelae in a substantial subset of patients. This study demonstrates the utility of echocardiography in intra-operative monitoring of surgical repair and highlights patients who are most likely to require return to bypass, as well as the co-morbidities of such manipulations.
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13
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Predischarge Transthoracic Echocardiography after Surgery for Congenital Heart Disease: A Routine with a Reason? J Am Soc Echocardiogr 2015; 28:1030-5. [DOI: 10.1016/j.echo.2015.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Indexed: 01/15/2023]
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14
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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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15
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Ingrande J, Lemmens HJ. Medical devices for the anesthetist: current perspectives. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:45-53. [PMID: 24707188 PMCID: PMC3971909 DOI: 10.2147/mder.s43428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Anesthesiologists are unique among most physicians in that they routinely use technology and medical devices to carry out their daily activities. Recently, there have been significant advances in medical technology. These advances have increased the number and utility of medical devices available to the anesthesiologist. There is little doubt that these new tools have improved the practice of anesthesia. Monitoring has become more comprehensive and less invasive, airway management has become easier, and placement of central venous catheters and regional nerve blockade has become faster and safer. This review focuses on key medical devices such as cardiovascular monitors, airway equipment, neuromonitoring tools, ultrasound, and target controlled drug delivery software and hardware. This review demonstrates how advances in these areas have improved the safety and efficacy of anesthesia and facilitate its administration. When applicable, indications and contraindications to the use of these novel devices will be explored as well as the controversies surrounding their use.
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Affiliation(s)
- Jerry Ingrande
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Hendrikus Jm Lemmens
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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16
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Guzeltas A, Ozyilmaz I, Tanidir C, Odemis E, Tola HT, Ergul Y, Bilici M, Haydin S, Erek E, Bakir I. The Significance of Transesophageal Echocardiography in Assessing Congenital Heart Disease: Our Experience. CONGENIT HEART DIS 2013; 9:300-6. [DOI: 10.1111/chd.12139] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Alper Guzeltas
- Department of Pediatric Cardiology; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Isa Ozyilmaz
- Department of Pediatric Cardiology; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Cansaran Tanidir
- Department of Pediatric Cardiology; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Ender Odemis
- Department of Pediatric Cardiology; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Hasan Tahsin Tola
- Department of Pediatric Cardiology; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Yakup Ergul
- Department of Pediatric Cardiology; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Meki Bilici
- Department of Pediatric Cardiology; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Sertac Haydin
- Department of Pediatric Cardiovascular Surgery; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Ersin Erek
- Department of Pediatric Cardiovascular Surgery; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Ihsan Bakir
- Department of Pediatric Cardiovascular Surgery; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
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Kim SJ, Park SA, Song J, Shim WS, Choi EY, Lee SY. The role of transesophageal echocardiography during surgery for patients with tetralogy of Fallot. Pediatr Cardiol 2013; 34:240-4. [PMID: 22790360 DOI: 10.1007/s00246-012-0423-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 06/22/2012] [Indexed: 11/30/2022]
Abstract
Routine use of intraoperative transesophageal echocardiography (TEE) is a safe monitoring and diagnostic method during pediatric congenital cardiac surgery. However, the question of whether intraoperative TEE is accurate and cost effective for patients with tetralogy of Fallot (TOF) has not been raised. This study aimed to analyze the cost-benefit of routine TEE during the repair of TOF. The medical records, including TEE results, for patients who underwent correction of TOF between January 1997 and June 2007 were reviewed and retrospectively analyzed. Intraoperative TEE was performed for 340 patients (85 %). Residual problems were detected in 17.9 % (61/340), and a return to bypass was needed for 10 % (34/340) of the patients. The degree of agreement between the intraoperative TEE and early postoperative transthoracic echocardiography (TTE) was relatively high. Surgeons with less surgical experience more frequently used intraoperative TEE (p = 0.007) and performed repeat bypass surgery at a higher rate (p = 0.00). Even relatively unskilled surgeons might be able to achieve surgical outcomes similar to those of experienced surgeons using intraoperative TEE. By avoiding late surgical revision, the possible cost savings were estimated to be 1,726,000 Korean won (US$1,489) per TEE examination. Intraoperative TEE can be used as a tool for surgeons in making decisions in the operating room. In addition, intraoperative TEE decreased the frequency of reoperations and postoperative interventions. The results of this study demonstrate that routine intraoperative TEE during repair of TOF was both clinically beneficial and cost effective.
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Affiliation(s)
- Soo-Jin Kim
- Department of Pediatric Cardiology, School of Medicine, Konkuk University, 4-12 Hwayng-dong, Gwangjin-gu, Seoul 143-729, Republic of Korea.
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Wellen SL, Glatz AC, Gaynor JW, Montenegro LM, Cohen MS. Transesophageal Echocardiography Probe Insertion Failure in Infants Undergoing Cardiac Surgery. CONGENIT HEART DIS 2012; 8:240-5. [DOI: 10.1111/chd.12027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Shari L. Wellen
- Division of Cardiology; Children's Hospital of Philadelphia; Philadelphia; Pa; USA
| | - Andrew C. Glatz
- Division of Cardiology; Children's Hospital of Philadelphia; Philadelphia; Pa; USA
| | - J. William Gaynor
- Division of Cardiology; Children's Hospital of Philadelphia; Philadelphia; Pa; USA
| | - Lisa M. Montenegro
- Division of Cardiology; Children's Hospital of Philadelphia; Philadelphia; Pa; USA
| | - Meryl S. Cohen
- Division of Cardiology; Children's Hospital of Philadelphia; Philadelphia; Pa; USA
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Royse CF, Canty DJ, Faris J, Haji DL, Veltman M, Royse A. Core review: physician-performed ultrasound: the time has come for routine use in acute care medicine. Anesth Analg 2012; 115:1007-28. [PMID: 23011559 DOI: 10.1213/ane.0b013e31826a79c1] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The use of ultrasound in the acute care specialties of anesthesiology, intensive care, emergency medicine, and surgery has evolved from discrete, office-based echocardiographic examinations to the real-time or point-of-care clinical assessment and interventions. "Goal-focused" transthoracic echocardiography is a limited scope (as compared with comprehensive examination) echocardiographic examination, performed by the treating clinician in acute care medical practice, and is aimed at addressing specific clinical concerns. In the future, the practice of surface ultrasound will be integrated into the everyday clinical practice as ultrasound-assisted examination and ultrasound-guided procedures. This evolution should start at the medical student level and be reinforced throughout specialist training. The key to making ultrasound available to every physician is through education programs designed to facilitate uptake, rather than to prevent access to this technology and education by specialist craft groups. There is evidence that diagnosis is improved with ultrasound examination, yet data showing change in management and improvement in patient outcome are few and an important area for future research.
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Affiliation(s)
- Colin F Royse
- Department of Surgery, The University of Melbourne, 245 Cardigan St., Carlton, Victoria, Australia, 3053.
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20
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Abstract
AIM To assess the quality of imaging modalities of a new micro multiplane transoesophageal echocardiogram probe. METHOD This is a prospective study of micro transoesophageal echocardiogram S8-3t probe used at a single institution between 15 December, 2009 and 15 March, 2010. The images were compared with standard paediatric or adult probes where possible. Assessors prospectively rated imaging quality - two dimensional, colour flow imaging, pulse wave, and continuous wave Doppler - with a subjective 4-point scale (1 = poor to 4 = excellent). RESULTS A total of 24 studies were performed on 23 patients, with a median weight = 11.7 kilograms (2.6-72 kilograms) and a median age of 3 years (0.16-60 years). Of the 23 patients, one neonate (2.8 kilograms) had transient bradycardia on probe insertion. Imaging in patients less than 10 kilograms was of full diagnostic value and new information was obtained in eight out of ten patients. Pulse wave and continuous wave Doppler was consistently good across all weight groups. There were high frame rates and good imaging quality to a depth of 4-6 centimetres in all studies. A comparison with a larger alternative probe was available for 12 studies (weight 11.9-72 kilograms). The median micro transoesophageal two-dimensional image quality score was 3 (2-4) and 4 (3-4) with the comparative probe. For the 10- to 30-kilogram group, image quality with the micro transoesophageal echocardiogram probe was judged as inferior to larger standard probes. Adult sized patients had good imaging of near the field, allowing guidance for percutaneous device closure of the atrial septum. CONCLUSION The micro multiplane transoesophageal echocardiogram probe provides imaging of diagnostic quality in neonates. In larger patients, it offers good imaging of near field structures. In the intermediate-sized child (10-30 kilograms), standard paediatric probes provide better imaging.
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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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Intraoperative Monitoring with Transesophageal Echocardiography in Cardiac Surgery. Braz J Anesthesiol 2011; 61:495-512. [DOI: 10.1016/s0034-7094(11)70058-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Accepted: 12/13/2010] [Indexed: 11/23/2022] Open
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23
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Nair SG. Pediatric cardiac program in India: changing perspectives. Ann Card Anaesth 2011; 14:79-81. [PMID: 21636925 DOI: 10.4103/0971-9784.81559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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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.
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Kamra K, Russell I, Miller-Hance WC. Role of transesophageal echocardiography in the management of pediatric patients with congenital heart disease. Paediatr Anaesth 2011; 21:479-93. [PMID: 21481076 DOI: 10.1111/j.1460-9592.2011.03570.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Transesophageal echocardiography (TEE) has become a critical diagnostic and perioperative management tool for patients with congenital heart disease (CHD) undergoing cardiac and noncardiac surgical procedures. This review highlights the role of TEE in routine management of pediatric cardiac patient population with focus on indications, views, applications and technological advances.
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Affiliation(s)
- Komal Kamra
- Department of Anesthesiology, Stanford University, Lucile Packard Children’s Hospital, Palo Alto, CA, USA.
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Naghipour B, Azarfarin R, Golzari SEJ, Golzari S, Mirinazhad M, Bilehjani E, Negargar S. Cost-effectiveness of intraoperative transesophageal echocardiography in cardiac valve surgery. J Cardiovasc Thorac Res 2011; 3:79-81. [PMID: 24250959 DOI: 10.5681/jcvtr.2011.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Accepted: 06/08/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Being a unique diagnostic technique, transesophageal echocardiography (TEE) has influenced many different aspects of cardiac surgery including valve repair surgery. The cost-effectiveness of this method however is questioned considering the conditions of every region and country. In this study we aimed at answering the question if utilizing TEE throughout valve repair surgery could be cost-effective. METHODS Twenty four patients were studied within two groups of case "valve repair operation plus intra-operative TEE (IO-TEE)" and control "valve replacement operation". Variables including age, gender, left ventricle ejection fraction (LVEF), re-operation, intensive care unit (ICU) stay, hospital stay and cost were studied and compared. RESULTS There was no significant difference regarding age, gender and LVEF between two groups (p=0.559, p=0.413, and p=0.408, respectively). ICU stay in repair group was less than replacement group (p=0.009). Hospital stay difference however was not statistically significant (p=0.928). The cost of valve repair under IO-TEE monitoring was significantly less than valve replacement (p=0.001). CONCLUSION IO-TEE not only would assist surgeons by increasing their interest toward valve repair operation instead of replacing impaired cardiac valves but also consequently decrease hospital costs. It is also advised for the cardiac anesthesiologists to use IO-TEE routinely in the valve repair operations provided that there are no contraindications.
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Affiliation(s)
- Bahman Naghipour
- Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran
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Pitkin AD, Blas ML, Klodell CT, Oware A, Augoustides JG. Case 4—2010Successful Use of Transesophageal Echocardiography After Esophagogastrectomy. J Cardiothorac Vasc Anesth 2010; 24:700-5. [DOI: 10.1053/j.jvca.2010.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Indexed: 12/28/2022]
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Alves da Silva A, Silva ED, Segurado AVR, Kimachi PP, Simões CM. Changes in Surgical Conduct Due to the Results of Intraoperative Transesophageal Echocardiography. Braz J Anesthesiol 2010. [DOI: 10.1016/s0034-7094(10)70025-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Ma XJ, Huang GY, Liang XC, Chen ZG, Jia B, Li X, Ye M. Transoesophageal echocardiography in monitoring, guiding, and evaluating surgical repair of congenital cardiac malformations in children. Cardiol Young 2007; 17:301-6. [PMID: 17445341 DOI: 10.1017/s1047951107000303] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2006] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the role of transoesophageal echocardiography and problems related to safety during the surgical repair of congenital cardiac malformations in children. METHODS We examined the transoesophageal recordings made in 350 children with congenital cardiac diseases, aged from 2 months to 17 years and 9 months, with a median age of 2.7 years, tracings having been taken both before and after cardiopulmonary bypass. All patients had been scanned by transthoracic echocardiography before the operative procedures. RESULTS Preoperative transoesophageal echocardiography added additional findings, or changed the diagnoses made using transthoracic echocardiography, in 33 cases (9.4%), among which the findings had therapeutic significance in 23 cases (6.6%) that altered the planned surgical procedures. Residual problems or sequels were detected by postoperative transoesophageal echocardiography in 57 cases (16.3%), with 13 patients (3.7%) requiring instant intervention or return to bypass for modifications of the surgical procedures. We encountered no severe complications due to the performance of transoesophageal echocardiography. Mild complications occurred in only 2 patients (0.6%). CONCLUSIONS Transoesophageal echocardiography is a useful tool with which to determine the strategies for treatment in the perioperative period, and to improve the quality of surgical procedures in children with congenital cardiac diseases. Complications were few, but still deserved careful attention to detail.
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Affiliation(s)
- Xiao-Jing Ma
- Paediatric Heart Center, Children's Hospital of Fudan University, Department of Paediatrics, Shanghai Medical School, Fudan University, Shanghai, People's Republic of China
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Schroeder RA, Bar-Yosef S, Mark JB. Intraoperative Hemodynamic Monitoring. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
We report a case involving a surgical sponge retained following an aortic valve replacement. The surgical sponge was placed into the left ventricle to protect calcified debris from falling down into the left ventricular cavity. However, the sponge was forgotten and left inside the patient. We identified the retained surgical sponge by transesophageal echocardiography, which was performed because of a difficulty in weaning the patient from the cardiopulmonary bypass.
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Affiliation(s)
- Yildirim Imren
- Department of Cardiovascular Surgery, Gazi University Medical Faculty, Ankara, Turkey.
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Affiliation(s)
- Pierre-Guy Chassot
- Department of Anaesthesiology, University Hospital of Lausanne, Lausanne, Switzerland.
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Prêtre R, Kadner A, Dave H, Dodge-Khatami A, Bettex D, Berger F. Right axillary incision: A cosmetically superior approach to repair a wide range of congenital cardiac defects. J Thorac Cardiovasc Surg 2005; 130:277-81. [PMID: 16077387 DOI: 10.1016/j.jtcvs.2005.03.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We sought to evaluate the safety of a right axillary incision, a cosmetically superior approach than anterolateral thoracotomy, to repair various congenital heart defects. METHODS All the patients who were approached with this incision between March 2001 and October 2004 were included in the study. There were 80 patients (median age, 4 years) with atrial septal defect closure (38 patients), repair of partial abnormal pulmonary venous return (14 patients), partial atrioventricular canal (16 patients), and perimembranous ventricular septal defect (12 patients). The surgical technique involved peripheral and central cannulation for institution of cardiopulmonary bypass. Electrically induced ventricular fibrillation was used for defects located in front of the atrioventricular valves, and cardioplegic arrest was used for those located at the level or behind these valves. RESULTS The repair was possible without need for conversion to another approach. One patient sustained a transient neurologic deficit. The patients were all in excellent condition after a mean follow-up of 14 months. The cardiac defect was repaired with no residual defect in 75 patients and with trivial residual defect in 5 patients (3 with mitral valve regurgitation, 1 with atrial septal defect, and 1 with ventricular septal defect). The incision healed properly in all, and the thorax showed no deformity. CONCLUSION The right axillary incision provides a quality of repair for various congenital defects similar to that obtained by using standard surgical approaches. Because it lies more laterally and is hidden by the resting arm, it provides superior cosmetic results compared with conventional incisions, including the anterolateral thoracotomy. Finally, the incision is unlikely to interfere with subsequent development of the breast.
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Affiliation(s)
- René Prêtre
- Pediatric Cardiac Surgery, Department of Surgery, University Hospital Zurich, Switzerland.
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Bettex DA, Prêtre R, Jenni R, Schmid ER. Cost-Effectiveness of Routine Intraoperative Transesophageal Echocardiography in Pediatric Cardiac Surgery: A 10-Year Experience. Anesth Analg 2005; 100:1271-1275. [PMID: 15845668 DOI: 10.1213/01.ane.0000149594.81543.f0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The beneficial effect of transesophageal echocardiography (TEE) on medical and surgical treatment of children with congenital heart disease has been established. Its cost-effectiveness, however, has not been extensively studied. We analyzed reports of 580 routine TEE examinations performed in our institution between January 1994 and December 2003 in patients younger than 17 yr who required congenital cardiac surgery. After excluding patients who died immediately postoperatively, we identified 33 patients (5.7%) who required a second bypass run on clear-cut indication, i.e., surgical reoperation, and who clearly benefited from TEE findings. An estimate of both fixed and variable costs revealed a savings of 850 to 2655 Swiss francs (CHF) ($690 to $2130 US) per child. This figure undoubtedly underestimates the true cost-effectiveness of routine intraoperative TEE in this setting because we used mostly conservative estimates of the benefits and liberal estimates of the costs. The potential benefits of TEE in hemodynamic monitoring and medical management, in reduction of postoperative morbidity, and in improvement in the quality of life are intangible and were not considered. Although benefits and costs vary according to market conditions, patient populations, surgical practice, and technical expertise with TEE, our analysis demonstrates substantial cost-effectiveness in the use of routine TEE during pediatric cardiac surgery.
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Affiliation(s)
- Dominique A Bettex
- Division of Cardiovascular Anesthesia, Clinic of Cardiovascular Surgery, and Division of Cardiology, University Hospital of Zurich, Zurich, Switzerland
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