Tips and Tricks of TEE in CHD Intervention

Abstract

Transesophageal echocardiography (TEE) now is considered an essential part of diagnostic and monitoring during modern cardiac and thoracic aortic surgery. Perioperative TEE is a major component of patient management, and important for surgical and anesthetic decision making. Frazin first introduced the clinical use of transesophageal echocardiography (TEE) in 1976. However, the pediatric TEE probe was established and use clinically in 1990. In 2009, the new microTEE probe (s8-3t Philip) was developed and brings benefits of the TEE to use in patients under 3Kg. Clinical management of congenital heart lesions by using the TEE can be achieved by surgical repair, via catheter-based device closure and during hybrid surgery. Therefore, in this presentation we review our experiences of using intraoperative TEE in pediatric patients who underwent different types of congenital heart surgery, interventional therapy and hybrid surgery. We reported that intraoperative TEE for 256 consecutive neonates and infants undergoing complex congenital heart surgery. TEE was successful performed in 97% of infants with CHD during surgery and only 3% failed due to systemic arterial hypotension and saturation in 7 infants (4 in TAPVC and 3 in CoA) only 5.6 % patients with inadequate surgical repair and need immediate revised. Interventional techniques for treatment of congenital heart disease are evolving rapidly and have become established routine in a large number of centers worldwide. TEE image was used to evaluate the size, number and location of the defects, selection of appropriate device, guiding the procedures and confirmed the results. Hybrid surgery for CHD, a new medical trend. It combined minimally-invasive method with traditional surgical techniques and catheter based procedure. Hybrid for HLHS (single ventricle palliation combing surgical PAB with catheter ductal stenting), periventricular closure of VSD, periventricular pulmonary stenosis, periventricular aortic valve replacement. In conclusion, TEE is routinely and successfully used during pediatric CHD surgery repair, intervention procedures and hybrid surgery to improve the quality of surgical repair and to potentially reduce the morbidity and mortality.