Preliminary evaluation of a microtransesophageal probe in neonates and young infants undergoing surgery for congenital heart disease

Abstract

Background:The larger size of the currently available transesophageal echocardiography (TEE) probes limits their use to relatively older infants undergoing cardiac surgery. In very young neonates and infants, epicardial echocardiogram is used to assess postoperative residual defects. Recently, a miniaturized microTEE probe compatible in neonates has been introduced for clinical use. We evaluated the use of this probe in small infants undergoing cardiac surgery.Materials and Methods:Thirty-three consecutive neonates and infants undergoing cardiac surgery at our institution were included in the study. Intraoperative echocardiography with Philips s8-3t microTEE probe done using IE33 platform was utilized to study the preoperative anatomy and assess postoperative results.Results:Thirty-three patients aged 3 days-2 years (mean 5.1 months) and weighing 2.5-11 kg (mean 4.4 kg) underwent perioperative evaluation using the microTEE probe. Good quality two-dimensional and color Doppler images were obtained in all patients. There were no complications related to the probe insertion or manipulation. The findings on microTEE led to revision of surgery in five patients. Certain echocardiographic parameters that could never be recorded with epicardial echocardiogram could be easily seen in microTEE.Conclusion:On preliminary evaluation, the microTEE probe provided good quality images in very small infants who were not amenable for transesophageal echocardiographic evaluation so far. The probe could be used safely in small infants without complications. It appears to be a promising imaging modality in the perioperative assessment of young infants undergoing cardiac surgery, in whom intraoperative epicardial echocardiography is currently the only tool.

Utility of a standardized postcardiopulmonary bypass epicardial echocardiography protocol for stage I Norwood palliation

“…Rather, we aimed to convey that it is the standardization of the approach, and following of a protocol, that increases rates of visualization. With the development of the miniaturized transducers, 23–24 which can be used in small neonates, and further advances in in technology, it may be that transesophageal echocardiography becomes preferable to e-echo. However, demonstration of adequate visualization of the vascular anatomy would need to be shown.…”

Feasibility of multiplane microtransoesophageal echocardiographic guidance in structural heart disease transcatheter interventions in adults

“…To overcome these limitations, the microTEE system (S8–3t, Philips Healthcare) might be an attractive alternative. This probe provided good quality images in very small infants [ 15 ]. Additionally, it could be demonstrated that the intraoperative and postoperative use of the microTEE probe provides adequate accuracy albeit inferior image quality when compared with the paediatric multiplane TEE probe in infants [ 7 , 16 ].…”

Recent advances in cardiac anaesthesia

“…A miniaturised microTEE probe (5.6 mm 32-element phased array transducer) is presently available for perioperative use for neonates. [ 22 ] Intracardiac echo (ICE) intravascular ultrasound transducer, an 8-Fr, 2.5-mm, 64-element crystal array is also available for use. The ICE probe must be advanced into the right atrium using an extra venous femoral approach (8 or 10 F), and cardiac images from inside the heart are imaged.…”