Routine Peri-Operative Transoesophageal Echocardiography in Paediatric Cardiac Surgical Procedures

Abstract

Introduction: Perioperative transoesophageal echocardiography (TOE) is recognised as a valuable diagnostic investigation for paediatric cardiac surgery, but is not performed on all cases in most centres. This study investigates the value of performing perioperative TOE for all procedures. Methods: All patients undergoing cardiac surgery between September 2011 and February 2012 had pre- and post-operative TOE studies. Demographic data, preoperative investigations, diagnosis and surgical procedure were documented prospectively. The influence of new diagnostic information determined by the pre-operative TOE on surgical procedure and the impact of post-operative TOE on subsequent surgical management was assessed. Results: Eighty-eight patients with median age 1.0 year (range; 4 days to 17.6 years) and weight 9.3 kg (range; 2.7–80 kg) were studied, with no TOE related complications. Twenty-five (28.4%) patients had cardiac catheters and four (4.5%) patients had cardiac magnetic resonance imaging as part of preoperative assessment. TOE was not possible in two (2.2%) cases. The preoperative TOE defined new information in six (7.0%) patients – new lesions identified in two; more detailed anatomic information which influenced surgical strategy in four. Post-operative TOE defined anatomical issues in five (5.8%) cases which resulted in further surgical intervention in four and a decision not to perform further surgery in one. The postoperative TOE findings did not differ from discharge assessments. Conclusions: This study demonstrates that perioperative TOE is an important adjunct for guiding surgical management. Performing TOE for every procedure is labour intensive, but the incidence of important findings which influenced management in this study, may support this strategy.