Intraoperative echocardiography in infants and children with congenital cardiac shunt lesions: Transesophageal versus epicardial echocardiography

Muhiudeen, Isobel A.; Roberson, David A.; Silverman, Norman H.; Haas, Gary; Turley, Kevin; Cahalan, Michael K.

doi:10.1016/0735-1097(90)90320-o

Cited by 100Congenital Heart Disease StudiesCardiovascular and Diving-Related ComplicationsCardiac and Coronary Surgery Techniques

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Intraoperative echocardiography in infants and children with congenital cardiac shunt lesions: Transesophageal versus epicardial echocardiography

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Muhiudeen, Isobel A., Roberson, David A., Silverman, Norman H., Haas, Gary, Turley, Kevin, Cahalan, Michael K.·1990·Journal of the American College of Cardiology

DOI 10.1016/0735-1097(90)90320-o

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Abstract

To determine the utility and limitations of intraoperative transesophageal echocardiography in infants and children with congenital intracardiac shunts, intraoperative transesophageal (n = 50) and epicardial (n = 49) echocardiograms were performed before and after cardiopulmonary bypass in children from 4 days to 16 years old and 3 to 45 kg in body weight. A miniaturized transesophageal probe (6.9 mm maximal diameter) was used in 36 patients weighting less than or equal to 20 kg. Epicardial imaging was performed with a 5 MHz precordial probe. The intraoperative transesophageal echocardiographic findings before and after cardiopulmonary bypass were correct and complete in 94% of patients. Transesophageal echocardiography correctly identified atrial septal defects, most types of ventricular septal defects, anomalous pulmonary veins, atrioventricular septal defects, tetralogy of Fallot, truncus arteriosus and double inlet ventricles. It failed to provide a correct diagnosis in only three patients, all of whom had doubly committed subarterial ventricular septal defects. Epicardial echocardiography identified all cases that had a doubly committed subarterial ventricular septal defect. A correct and complete intraoperative diagnosis was obtained with the use of epicardial imaging in 92% before and after cardiopulmonary bypass, but this technique required interruption of surgery and could not be completed in three patients because of induced arrhythmias and hypotension. These results demonstrated that intraoperative transesophageal echocardiography consistently defined important morphologic, color and pulsed Doppler ultrasound features of most congenital shunt lesions. Lesions that involved the right ventricular outflow tract are sometimes difficult to image with uniplane transesophageal echocardiography. There were no complications in any of the 50 subjects.

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Epicardial echocardiography is often chosen over transesophageal echocardiography for assessing certain anatomy and in small infants and neonates.
“However, epicardial echo (e-echo) is often preferred over the transesophageal approach for evaluation of certain anatomy, and in small infants and neonates.9–12”
From Utility of a standardized postcardiopulmonary bypass epicardial echocardiography protocol for stage I Norwood palliation: STERN et al. (2017) · cites this paper as [11]

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Intraoperative Echocardiography for Evaluation of Congenital Heart Defects in Infants and Children
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Authors: Muhiudeen, I. A., Roberson, D. A., Silverman, N. H., Haas, G., Turley, K., & Cahalan, M. K.
Affiliations: University of California, San Francisco (US)
Corresponding author: Muhiudeen, Isobel A.
ORCID: Roberson, David A.
Turley, Kevin
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 1990-12
Volume: 16
Issue: 7
Pages: 1687-1695
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/0735-1097(90)90320-o
OpenAlex: W1990802714
Cited by: 100
References: 18
Citations by year: 2023: 1 · 2022: 2 · 2021: 8 · 2020: 2 · 2019: 2 · 2018: 3 · 2017: 4 · 2016: 2 · 2013: 4 · 2012: 1
FWCI: 10.06
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 8263 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (2p01ag003104-06)
National Institute on Aging (2PO1AG03104-09)
National Heart, Lung, and Blood Institute (HL07544, T32HL007544)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Congenital Heart Disease Studies
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
Keywords: intraoperative echocardiography, transesophageal echocardiography, epicardial echocardiography, congenital heart disease, intracardiac shunt, cardiopulmonary bypass, infants and children, atrial septal defect, ventricular septal defect, tetralogy of Fallot, truncus arteriosus, double inlet ventricle, atrioventricular septal defect, anomalous pulmonary vein, right ventricular outflow tract, diagnostic accuracy
MeSH terms: Cardiopulmonary Bypass, Child, Echocardiography, Esophagus, Heart Defects, Congenital, Humans, Infant, Infant, Newborn, Monitoring, Intraoperative

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Intraoperative echocardiography in infants and children with congenital cardiac shunt lesions: Transesophageal versus epicardial echocardiography

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