Intraoperative transesophageal echocardiography during surgery for congenital heart defects
Open accessAbstract
Objective This study was undertaken to further define the impact of intraoperative transesophageal echocardiography during surgery for congenital heart disease and to determine appropriate indications.Methods The impact of transesophageal echocardiography on patient care was assessed in 1002 patients who underwent this procedure during surgery for congenital heart defects. It had major impact when new information altered the planned procedure or led to a revision of the initial repair. The safety of intraoperative transesophageal echocardiography was evaluated by review of the prospective data sheets and the medical record. A simple relative cost analysis was also performed.Results Patient median age was 9.9 years (range 2 days to 85 years). Transesophageal echocardiography had prebypass or postbypass major impact in 13.8% of cases (n = 138/1002). Major impact was more frequent during reoperations (P <.03). Procedures that benefited most from the additional information were valve repairs (aortic or atrioventricular) and complex outflow tract reconstructions. Partial anomalous pulmonary venous connection, tricuspid valve repair (other than of Ebstein anomaly), simple atrioventricular discordance, aortic arch anomalies, and secundum atrial septal defects had major impact rates less than 5%. No major complications occurred. Minor complications occurred in 1% of patients and were most often observed in infants smaller than 4 kg. Routine use of transesophageal echocardiography for all patients with congenital heart defects proved cost-effective.Conclusions On the combined basis of the observed rates of major impact, the minimal complications, and the relative cost advantage, we believe that routine use of transesophageal echocardiography during most intracardiac repairs of congenital heart defects is justified, particularly for patients undergoing repeat operations for congenital cardiac malformations.
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Indications and Guidelines in Pediatric and Congenital Heart Disease
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- Authors
- Randolph, G. R., Hagler, D. J., Connolly, H. M., Dearani, J. A., Puga, F. J., Danielson, G. K., Abel, M. D., Pankratz, V. S., & O'Leary, P. W.
- Affiliations
- Mayo Clinic (US)
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2002-12
- Volume
- 124
- Issue
- 6
- Pages
- 1176-1182
- ISSN
- 0022-5223 (ISSN-L)
- OpenAlex
- W2036946955
- Cited by
- 141
- References
- 18
- Citations by year
- 2025: 5 · 2024: 2 · 2023: 4 · 2022: 2 · 2021: 8 · 2020: 2 · 2019: 4 · 2018: 13 · 2017: 5 · 2016: 7 · 2015: 5 · 2014: 7 · 2013: 9 · 2012: 10
- FWCI
- 3.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Mayo Clinic
- Mayo Foundation for Medical Education and Research
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Keywords
- intraoperative transesophageal echocardiography, congenital heart disease, cardiac surgery, reoperation, valve repair, Ebstein's anomaly, tricuspid valve repair, atrioventricular discordance, aortic arch anomalies, secundum atrial septal defect, partial anomalous pulmonary venous return, procedural complications, cost-effectiveness
- MeSH terms
- Child, Cost-Benefit Analysis, Costs and Cost Analysis, Heart Defects, Congenital, Humans, Intraoperative Care, Reoperation, Safety, Echocardiography, Transesophageal
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