Intraoperative Transesophageal Echocardiography to Evaluate Pediatric Patients Undergoing Atrial Septal Defect Procedure

Abstract

Introduction: Atrial septal defects (ASD) are a type of congenital heart disease that are characterized by a communication between the left atrium with the right atrium. Preoperative intraoperative transesophageal echocardiography (TEE) evaluates cardiac anatomy and function. The objective of this paper was to compare the use of intraoperative TEE in corrective surgeries for ASD in pediatric patients. Material and Methods: After approval by the local Ethics Committee for Research, a retrospective descriptive study was conducted in children aged 3 to 18 years who underwent an ASD repair between January 2011 and January 2015 divided in two groups: TEE group (n=24) and No-TEE group (n=28). Were assessed the demographic data, Qp/Qs ratio, pulmonary hipertension (PH), left ventricle ejection fraction (EF), and major clinical outcomes. Results: There were differences between the two groups in demographics data in age and wieght that were higher in the No-TEE group. There were no differences between the two groups in pulmonary infection, renal dysfunction, congestive heart failure, time of extubation in the ICU and intra-hospital mortality. There was 4% atrial arrhythmias in the TEE group and 0% in the No-TEE group (p=0.46). The No-TEE group showed more time to wean from CPB (35.1 ± 17.3 minutes vs 43.6 ± 27.2 minutes; p=0.01) and more time to release from ICU than TEE-group (42 ± 13.2 hours vs 58.9 ± 30.4 hours, p=0.01). Conclusions: We concluded that the use of intraoperative TEE is safe and economically feasible. It enables an assessment of cardiac anatomy and functions in the pre-CPB period and guide the weaning from CPB with lower time of CPB and ICU length stay than No-TEE group.