Usefulness of perioperative transesophageal echocardiography during pediatric cardiac surgery

Abstract

Pediatric transesophageal echocardiography (TEE) probes allow perioperative evaluation during pediatric congenital heart disease (CHD) surgery. To determine the usefulness of perioperative TEE for evaluation of residual lesions severity according to the type of repaired CHD. Retrospective review of patients who underwent a perioperative TEE study during open-heart surgery (excluding ostium secundum atrial septal defect closure) over 4 consecutive years in our center. Residual lesions were rated as mild, moderate or severe. Among 291 interventions (which may include multiple gestures) in 280 patients (pts), no complications related to TEE study occurred. Median weight was 8,1 kg (range 2–96) and size of probe (micro 2D TEE, mini-multi 2D TEE or 3D TEE) adapted to the weight. Twenty-one (7.2%) severe residual lesions required immediate reintervention. Eleven pts (9.7%) had severe residual stenosis and required immediate reintervention out of 113 right ventricular outflow tract obstruction (RVOTO) surgeries. Three pts (3.5%) required immediate reintervention for aortic regurgitation and two (2.3%) for mitral residual lesions out of 86 left heart surgeries. Two pts (1.1%) required immediate reintervention for severe residual VSD out of 188 ventricular shunt surgeries. Two pts (4.2%) required immediate reintervention for superior vena cava stenosis following Warden procedure out of 47 pretricuspid shunt surgeries. One immediate reintervention occurred after a “Cone surgery” for severe right ventricle dysfunction. Use of perioperative TEE is safe and provides accurate information of residual lesions leading to several immediate intervention. RVOTO, left valvular and shunt closure surgeries could most likely benefit of its use.