Intravascular ultrasound catheter for transesophageal echocardiography in congenital heart surgery -A case report-

Abstract

Transesophageal echocardiography (TEE) has an important role during congenital heart surgery. TEE in small infants is associated with complications, including an inability to pass the TEE probe, esophageal trauma, airway compression, aortic compression, and interference with ventilation. Recently, a monoplane intravascular ultrasound catheter (IVUC) has been developed for intracardiac echocardiography. The efficacy of IVUC for transesophageal use has been shown in numerous animal studies and several human studies, but there have been few reports involving small infants using an IVUC probe. We examined 15 pediatric patients undergoing congenital cardiac surgery using an 8-Fr AcuNav IVUC probe. We checked the cardiac anatomy, cardiac function pre-operatively and de-aeration before weaning from CPB; the surgical repairs were evaluated post-operatively. Although the IVUC probe has limitations associated with the monoplane, we found the IVUC probe to be useful in small infants and safer than the TEE.

Transesophageal Echocardiography in Critically Ill Acute Postoperative Infants: Comparison of AcuNav Intracardiac Echocardiographic and microTEE Miniaturized Transducers

“…However, Bruce et al 26 monitored esophageal temperatures with a thermistor during intracardiac TEE and found no complications. Likewise, we and other investigators [25][26][27][28][29] did not encounter any apparent complications related to esophageal burn or trauma. However, because of the theoretical but very unlikely possibility 27 of esophageal thermal injury, we limit our intracardiac transesophageal echocardiographic imaging time to not more than 15 min.…”

“…Drinker et al 28 performed intraoperative studies on 11 infants weighing 2 to 4 kg, finding the AcuNav ICE transducer safe and effective. Kim et al 29 analyzed 15 intraoperative infants weighing 2 to 5 kg and confirmed efficacy and safety in the operative clinical setting. The major potential safety limitation with the use of the AcuNav ICE transducer is the lack of a thermistor for temperature monitoring.…”

“…The transducer was manufactured for intravascular use, but it has also been used for TEE in infants and small animals. [25][26][27][28][29] We must emphasize that the AcuNav ICE transducer is being used ''off label'' for TEE.…”

“…[30][31][32] We herein present our experience with TEE using both the AcuNav ICE transducer and the microTEE transducer in this challenging patient population and clinical setting. In addition, we review previous published reports on the use of these transducers [27][28][29][30][31][32] in small children.…”

“…Formerly, the only option available in this setting was the AcuNav intracardiac echocardiographic (ICE) transducer (Siemens Medical Solutions USA, Inc., Mountain View, CA), which was found to be relatively safe and effective because of its availability, small size, and ease of use. [24][25][26][27][28][29] Recently, reports regarding the use of the microTEE miniaturized multiplane transesophageal echocardiographic probe (Philips Medical Systems, Andover, MA) in children have been published. [30][31][32] We herein present our experience with TEE using both the AcuNav ICE transducer and the microTEE transducer in this challenging patient population and clinical setting.…”