Epicardial Echocardiography in Pediatric and Congenital Heart Surgery

Stern, Kenan W.D.; Emani, Sitaram M.; Peek, Giles J.; Geva, Tal; Kutty, Shelby

doi:10.1177/2150135119838414

Cited by 24 publications

(8 citation statements)

References 31 publications

(45 reference statements)

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“…As a result, it is now possible to dedicate focused surgical attention to all morphological details without the pressure of time constraints in order to provide complete surgical repairs for most congenital heart defects lesions. Immediate assessment of surgical results has been provided by improved intra-operative surface and/or transesophageal echocardiography before and after the procedure (31,32). Furthermore, significant advances in perioperative support to critically ill infants and children with congenital heart defects have been achieved with readily available and improved extracorporeal membrane oxygenation techniques.…”

Section: Review Methodsmentioning

confidence: 99%

A narrative review of modern approach and outcomes evaluation in congenital heart defects

Corno¹,

LaPar²,

Wen³

et al. 2021

Transl Pediatr

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Objective: The purpose of this review is to highlight critical advances and innovative approaches to the most challenging clinical situations in congenital heart surgery, to establish a new perspective from which to evaluate current clinical practice patterns and contemporary United States program ranking systems. Background:The past decades have witnessed substantial advances in the treatment of congenital heart defects. New strategies are deeply rooted in calculated risk-taking innovations. Pioneer surgeons developed, improved and refined critical operative skills and techniques to optimize cardiovascular physiology, decrease operative mortality and improve clinical outcomes.Methods: Unfortunately, in the modern surgical era, supportive environments to allow surgeons to make similar gains and innovative contributions remain scarce. In the current practice, overall procedure volume is prioritized to safeguard quality metrics, including hospital survival and length of stay, surgical complications, and neurocognitive outcomes. As a result, exceptional surgical results have become translated and defined by public ranking systems such as the US News and World Report Best Children's Hospital National Ranking (USNWR) and the Congenital Heart Surgery Database of the Society for Thoracic Surgeons (CHSD-STS), primary based upon early post-operative mortality. This reality places surgeons in a vulnerable position where pressure to achieve a high clinical ranking contrasts with a surgeon definition of "acceptable" surgical risk. Currently, the most frequently used risk stratification tools do not factor in important differences in strategies, such as staged palliation versus complete repair, or bi-ventricular versus uni-ventricular physiology. This favors hospitals pursuing multistage surgical approaches, even if the result is worse long-term morbidity, mortality and increased resource utilization. This economy of ranking-based decision-making causes surgeons either avoid operating altogether or accept less advantageous multi-staged treatment strategies for patients with elevated expected mortality. Such an environment also might present much farther-reaching negative impacts on the growth and development of junior surgeons and trainees, as well as on the pursuit of new surgical innovations to aid future generations of patients.Conclusions: Risk aversive surgical behavior is creating an environment not favorable for the children born with truly complex congenital heart defects.

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Section: Review Methodsmentioning

confidence: 99%

A narrative review of modern approach and outcomes evaluation in congenital heart defects

Corno¹,

LaPar²,

Wen³

et al. 2021

Transl Pediatr

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show abstract

“…Importantly, a transesophageal echocardiogram is utilized to monitor the presence of existing or the development of new AI immediately after VAD implantation. Intraoperatively, an epicardial echocardiogram ( 29 , 30 ) may provide alternative views of the semilunar or atrioventricular valves if the transthoracic or transesophageal approaches do not provide a complete assessment of the valves. Cardiac magnetic resonance, usually obtained to assess ventricular function, fibrosis, and cardiac anatomy, can be particularly useful for quantifying the degree of valvular regurgitation or stenosis prior to VAD implantation ( 31 , 32 ).…”

Section: Diagnosis Of Valvular Heart Disease In Children Undergoing V...mentioning

confidence: 99%

Considerations of valvular heart disease in children with ventricular assist devices

Sood

Biniwale

et al. 2023

Front. Cardiovasc. Med.

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Ventricular assist devices have become a valuable tool in the treatment of heart failure in children. The use of ventricular assist devices has decreased mortality in children with end-stage heart failure awaiting transplant. It is not uncommon for children with end-stage heart failure associated with cardiomyopathy or congenital heart disease to have significant systemic semilunar and atrioventricular valve regurgitation, which can impact the efficiency and efficacy of hemodynamic support provided by a ventricular assist device. Therefore, implanting clinicians should carefully assess for valve abnormalities that may need repair and impact device selection and cannulation strategy to effectively support this diverse population. The purpose of this review is to provide an overview of this important and relevant topic and to discuss strategies for managing these patients.

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“…In this regard, it has been more than 60 years since the introduction of echocardiography, and thereafter this technology has been mainly used by cardiologists to help assess the anatomy and physiology of heart abnormalities (6). In addition, the use of echocardiography to assess very ill patients has expanded, especially for patients after heart surgery (7). Also, in recent years, it has been mainly used for diagnosis and monitoring in the intensive care unit (8).…”

Section: Introductionmentioning

confidence: 99%

Relationship between cardiac ultrasound findings during cardiopulmonary resuscitation with the outcome of patients

Seyedhosseini

Ahmadi

Karimialavijeh

et al. 2022

J Emerg Pract Trauma

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Objective: Cardiopulmonary arrest is a devastating outcome of some clinical situations and requires strict implementation of cardiopulmonary resuscitation (CPR) protocols. Since ultrasound is one of the recommended tools to determine the presence of cardiac movements and may be a predictor of the outcome, this study examined the relationship between echocardiographic findings during CPR with patients’ outcomes. Methods: This cross-sectional prospective observational study was conducted on patients with cardio-respiratory arrest in the emergency department of Shariaty hospital during 2019. sampling method was random. Echocardiography was done at the patient’s bedside during the CPR process in accordance with the last advanced cardiac life support (ACLS) guidelines, on two points, after the end of the second and 10th minutes from the start of CPR. The echocardiography findings (cardiac movement vs standstill) were recorded, and patient outcomes were followed. Thirty-two patients enrolled in this study with a mean age of 56.9±15.3 years. Chi-square and Mann-Whitney U tests were used to calculate the association between heart contractions during resuscitation and the outcomes via SPSS V.22. Fisher’s exact test and Kruskal-Wallis test were used to evaluate the relationship between heart rhythm in the second and tenth minutes with the outcomes of CPR. Results: The presence of cardiac movement in the 10th minute of CPR, in contrast to the findings of the second minute, had a significant correlation with the success rate of CPR and outcomes (P<0.05). Moreover, patients with ventricular tachycardia (VT)/ventricular fibrillation (VF) cardiac rhythm had a better resuscitation rate, 24-hour survival rate, and better outcome than patients with other cardiac rhythms and asystole (P<0.05). Conclusion: Echocardiographic findings in the 10th minute of the CPR process can be used as a prognostic factor for cardiac arrest.

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Epicardial Echocardiography in Pediatric and Congenital Heart Surgery

Cited by 24 publications

References 31 publications

A narrative review of modern approach and outcomes evaluation in congenital heart defects

A narrative review of modern approach and outcomes evaluation in congenital heart defects

Considerations of valvular heart disease in children with ventricular assist devices

Relationship between cardiac ultrasound findings during cardiopulmonary resuscitation with the outcome of patients

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