Comparison of Intraoperative Transesophageal Echocardiography to Epicardial Imaging in Children Undergoing Ventricular Septal Defect Repair

Wienecke, Matthew M.; Fyfe, Derek A.; Kline, Charles H.; Greene, Craig A.; Crawford, Fred A.; Sade, Robert M.; Gillette, Paul C.

doi:10.1016/s0894-7317(14)80220-4

Cited by 27 publications

(8 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[1][2][3][4] Onethird of our patients undergoing VSD closure had some evidence for residual Doppler color ow across the ventricular septum in the operating room; however, two-thirds of these were not seen on TTE by the time of discharge from the hospital. [1][2][3][4] Onethird of our patients undergoing VSD closure had some evidence for residual Doppler color ow across the ventricular septum in the operating room; however, two-thirds of these were not seen on TTE by the time of discharge from the hospital.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Ventricular Septal Defect Repair Using Intraoperative Transesophageal Echocardiography: Frequency and Significance of Residual Defects in Infants and Children

et al. 2000

View full text Add to dashboard Cite

Intraoperative transesophageal echocardiography (IOTEE) is commonly used to assess for residual defect and the need to return to bypass after repair of ventricular septal defect (VSD). The frequency and significance of residual septal defects as noted on IOTEE has not been well defined. We evaluated the frequency of residual VSD via IOTEE and the relationship between size of a residual VSD and rate of reoperation. In addition, we looked at the relationship between the presence of a residual VSD via IOTEE and the presence of residual VSD at follow-up transthoracic echocardiography (TTE). Residual VSD was measured via the largest width of the Doppler color jet diameter originating at the left ventricular septal surface. Of the 294 patients evaluated with IOTEE after VSD repair, one-third had a residual defect by IOTEE Doppler color flow mapping. Two-thirds of these defects closed spontaneously on TTE by the time of hospital discharge. There was no difference in frequency of residual VSD between simple (VSD closure alone, n = 90) and complex (VSD with associated lesions, n = 204) repair. Return to bypass with immediate reoperation was undertaken in nine patients, all of whom had significant shunt via oximetry (Qp/Qs > 1.5:1.0). All had residual VSD color jet diameters > 3 mm. Seven patients had residual color jet equal to 3 mm; however, hemodynamic studies did not reveal a significant shunt and none of these had reoperation. Seven patients with no VSD or < 3 mm residual VSD via had late reoperation to close residual VSD at 4 days to 5 months after initial operation. These were due to patch dehiscence or development of an "intramural" VSD in patients with conotruncal anomaly. A residual defect on IOTEE color Doppler measuring > or = 4 mm predicts the need for immediate reoperation, while a 3 mm defect may be significant and requires additional intraoperative hemodynamic evaluation. The majority of small defects noted on IOTEE are not present at discharge TTE. Patients with conotruncal defect repair should be followed closely for development of late significant "intramural" defects.

show abstract

Section: Discussionmentioning

confidence: 99%

Evaluation of Ventricular Septal Defect Repair Using Intraoperative Transesophageal Echocardiography: Frequency and Significance of Residual Defects in Infants and Children

et al. 2000

View full text Add to dashboard Cite

show abstract

“…Previous studies have demonstrated the accuracy of intraoperative transesophageal echocardiography when compared with simultaneous epicardial echocardiography for the assessment of residual ventricular septal defect [8,10,17] or mitral regurgitation [6,14] in the immediate postbypass period. Other investigators have reported reinstitution of cardiopulmonary bypass in order to address residual lesions identified by transesophageal examinations [2,4,12,13,14].…”

Section: Discussionmentioning

confidence: 99%

Utility of Intraoperative Transesophageal Echocardiography in the Assessment of Residual Cardiac Defects

et al. 1998

View full text Add to dashboard Cite

To investigate the accuracy of immediate postbypass transesophageal echocardiography in the assessment of residual cardiac defects, we compared intraoperative transesophageal echocardiograms with intra/postoperative data in 86 patients, aged 4 days to 30.7 years (median = 1.4 years), at risk for a total of 174 postoperative lesions: right (n = 55) or left (n = 26) ventricular outflow tract obstruction, ventricular septal defect (n = 65), aortic (n = 12) or mitral regurgitation (n = 8), or mitral stenosis (n = 8). Accuracy of intraoperative transesophageal echocardiography was evaluated based on comparison with (1) immediate post-bypass left (n = 4) or right (n = 9) ventricular outflow tract pressure gradients by pullback in the operating room, (2) direct surgical inspection of residual ventricular septal defects (n = 3), (3) pulmonary artery oxygen saturation (n = 49), (4) right ventricular outflow tract pullback gradient (n = 24), and (5) transthoracic echocardiogram (n = 51) performed within 40 days of surgery. The results indicate that intraoperative transesophageal echocardiography agreed with intra/postoperative data in 87% of patients at risk for right ventricular outflow tract obstruction, 96% at risk for left ventricular outflow tract obstruction, 97% at risk for ventricular septal defect, and 100% at risk for aortic regurgitation, mitral regurgitation, or mitral stenosis. Significant residual lesions led to immediate surgical revision in 11 cases: 3 ventricular septal defects, 6 right and 2 left ventricular outflow tract obstructions. Of these, intraoperative transesophageal echocardiography confirmed and quantified suspected residual lesions in 7 and identified unsuspected lesions in 4 cases. Immediate postbypass transesophageal echocardiography proved reliable for assessing residual ventricular septal defect, mitral stenosis, and mitral or aortic regurgitation. Although accurate for assessment of the left and right ventricular outflow tracts in most patients, transesophageal echocardiography may not reliably reflect the severity of obstruction in all cases.

show abstract

“…At times, this may be noted just upon passing the unflexed probe to the retrocardiac position, and at other times, dampening may occur when the probe is flexed. [93][94][95][96][97][98][99][100][101][102][103][104][105][106][107][108][109][110][111]. It is recommended that a thorough examination be performed of all aspects of a given repair, followed by a complete examination of chambers, valves and vessels for unexpected findings.…”

Section: Evaluation Of the Repairmentioning

confidence: 99%

Transesophageal Echocardiography

Stevenson

2009

Echocardiography in Pediatric and Congenital Heart Disease

View full text Add to dashboard Cite

Comparison of Intraoperative Transesophageal Echocardiography to Epicardial Imaging in Children Undergoing Ventricular Septal Defect Repair

Cited by 27 publications

References 24 publications

Evaluation of Ventricular Septal Defect Repair Using Intraoperative Transesophageal Echocardiography: Frequency and Significance of Residual Defects in Infants and Children

Evaluation of Ventricular Septal Defect Repair Using Intraoperative Transesophageal Echocardiography: Frequency and Significance of Residual Defects in Infants and Children

Utility of Intraoperative Transesophageal Echocardiography in the Assessment of Residual Cardiac Defects

Transesophageal Echocardiography

Contact Info

Product

Resources

About