The impact of additional epicardial imaging to transesophageal echocardiography on intraoperative detection of residual lesions in congenital heart surgery
Open accessAbstract
Objective Transesophageal echocardiography is the primary intraoperative imaging modality used to evaluate cardiac surgery. Its predecessor, epicardial echocardiography, enables visualization of certain cardiovascular structures that are beyond the visual scope of transesophageal echocardiography. We review the current use of epicardial echocardiography to analyze its contemporary application and benefit.Methods A retrospective review of the intraoperative echocardiograms of 1204 children undergoing bypass cardiovascular surgery between January 2007 and December 2009 was performed. The incidence of epicardial echocardiography use, intraoperative revisions, and early reinterventions were analyzed.Results Epicardial echocardiography was performed in 7.9% of all intraoperative studies: epicardial echocardiography alone (n = 38) and transesophageal echocardiography + epicardial echocardiography (n = 57). Epicardial echocardiography alone was performed in patients with contraindications for transesophageal echocardiography. In the transesophageal echocardiography + epicardial echocardiography group, indications to obtain additional information by epicardial echocardiography were for the assessment of branch pulmonary arteries (40%), coronary arteries (28%), aortic arch/Blalock-Taussig shunt (14%), Glenn/Fontan circuit (9%), pulmonary veins/baffles (7%), and residual ventricular septal defects (1.7%). The overall intraoperative surgical revision incidence was 10.2%, consisting of 21% of the transesophageal echocardiography + epicardial echocardiography group, 5.3% of the epicardial echocardiography alone group (P = .01), and 9.8% of transesophageal echocardiography alone group (P = .02). Intraoperative revisions indicated after epicardial echocardiography were mostly related to extracardiac structures (77%), whereas they were mostly related to intracardiac structures in the transesophageal echocardiography alone group (80.7%) (P = .0002). Early reintervention was indicated mostly for pulmonary artery and Glenn obstructions, the majority (75%) with previously known stenosis or interventions on the pulmonary arteries.Conclusions Epicardial echocardiography detects residual intraoperative lesions not visualized by transesophageal echocardiography, most frequently related to pulmonary arteries. Its use, in addition to standard transesophageal echocardiography, may decrease the need for early reintervention.
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Few data have been published on intraoperative echocardiography for Stage 1 Norwood palliation.
“Little data on intraoperative echo for S1NP has been published.”
From Utility of a standardized postcardiopulmonary bypass epicardial echocardiography protocol for stage I Norwood palliation: STERN et al. (2017) · cites this paper as [12]
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 [12]
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- Authors
- Dragulescu, A., Golding, F., Van Arsdell, G., Caldarone, C., Mertens, L., Al-Radi, O., & Lee, K.-J.
- Affiliations
- University of Toronto (CA)
- King Abdulaziz University (SA)
- Corresponding author
- Lee, Kyong-Jin
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2012-02
- Volume
- 143
- Issue
- 2
- Pages
- 361-367.e1
- ISSN
- 0022-5223 (ISSN-L)
- OpenAlex
- W1980886527
- Cited by
- 35
- References
- 20
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 3 · 2023: 3 · 2022: 2 · 2021: 3 · 2020: 3 · 2019: 3 · 2018: 2 · 2017: 3 · 2016: 2 · 2015: 1 · 2014: 2 · 2013: 3 · 2012: 1
- FWCI
- 1.44
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- www.elsevier.com/legal/tdmrep-license (tdm)
- www.elsevier.com/open-access/userlicense/1.0/ (vor, 1617 d)
- doi.org/10.15223/policy-017 (stm-asf)
- doi.org/10.15223/policy-037 (stm-asf)
- doi.org/10.15223/policy-012 (stm-asf)
- doi.org/10.15223/policy-029 (stm-asf)
- doi.org/10.15223/policy-004 (stm-asf)
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Keywords
- epicardial echocardiography, transesophageal echocardiography, congenital heart surgery, intraoperative imaging, residual lesions, pulmonary artery stenosis, ventricular septal defect, pediatric cardiac surgery, coronary arteries, Blalock-Taussig shunt
- MeSH terms
- Cardiac Catheterization, Heart Defects, Congenital, Cardiac Surgical Procedures, Humans, Intraoperative Care, Ontario, Pericardium, Predictive Value of Tests, Pulmonary Artery, Reoperation, Retrospective Studies, Chi-Square Distribution, Logistic Models, Treatment Outcome, Coronary Angiography, Echocardiography, Transesophageal, Echocardiography, Doppler, Color
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