Utility of a standardized postcardiopulmonary bypass epicardial echocardiography protocol for stage I Norwood palliation: STERN et al.
Open accessAbstract
OBJECTIVE: Stage 1 Norwood palliation is one of the highest risk procedures in congenital cardiac surgery. Patients with superior technical performance scores have more favorable outcomes. Intraoperative epicardial echocardiography may allow the surgeon to address residual lesions prior to leaving the operating room, resulting in improved technical performance. The ability of intraoperative epicardial echocardiography to visualize the relevant anatomy and its association with outcomes is not known. DESIGN: A standardized intraoperative epicardial echocardiography protocol was developed and performed at the conclusion of Stage 1 Norwood palliation. Data pertaining to visualization of relevant anatomy, and comparison of intraoperative echocardiogram findings with other postoperative investigations was performed. Clinical outcomes, including technical performance, were collected. A historical cohort who received either no echocardiogram or a nonstandardized examination was used as a comparison group. RESULTS: Thirty on-protocol and 30 preprotocol patients, 22 of whom had a nonstandardized intraoperative epicardial echocardiogram, were studied. Compared with preprotocol, visualization of the relevant anatomy was significantly increased for the Damus-Kaye-Stansel anastomosis (93% vs. 68% P = .03) and branch pulmonary arteries (70% vs. 36%, P = .02). One residual lesion requiring immediate operative reintervention was diagnosed in the preprotocol group. There were 5 patients in each cohort with residual lesions during the postoperative hospitalization that were not appreciated on the intraoperative echocardiogram. Technical performance, rates of reintervention and clinical outcomes were not significantly different between the two groups. CONCLUSIONS: Intraoperative epicardial echocardiography is technically feasible and increases visualization of the relevant anatomy. Larger investigations may be warranted to determine if there is clinical benefit to such an approach.
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- Findingown data
Five patients in each cohort had residual lesions during the postoperative hospitalization that were missed by the intraoperative echocardiogram.
“There were 5 patients in each cohort with residual lesions during the post-operative hospitalization that were not appreciated on the intraoperative echocardiogram.”
- Also stated in: § Epicardial echocardiography findings · plain
“There were 5 patients each from the pre- and on-protocol cohorts with residual lesions noted during the S1NP hospitalization that were not appreciated on the e-echo.”
- Also stated in: § DISCUSSION · hedged
“There were 5 patients each from both the pre- and on-protocol cohorts who could be considered to have had “false negatives” – lesions that were detected during the post-S1NP hospitalization that were not present on the e-echo.”
Quote in the paperSubstantial claim - Also stated in: § Epicardial echocardiography findings · plain
- Findingown data
The duration of epicardial echocardiography did not differ between the pre-protocol and on-protocol groups.
“The duration of the e-echo did not differ between the two groups.”
- Also stated in: § DISCUSSION · plain
“did not add a significant amount of imaging time to the operation over a non-standardized approach”
- Also stated in: § DISCUSSION · plain
“did not increase study time or complications”
Quote in the paperSubstantial claim - Also stated in: § DISCUSSION · plain
- Findingown data
Visualization of the branch pulmonary arteries was significantly more frequent in the on-protocol cohort than in the pre-protocol cohort (70% vs. 36%, P=0.02).
“Compared with pre-protocol, visualization of the relevant anatomy was significantly increased for the Damus-Kaye-Stansel anastomoses (93% vs. 68% P=0.03) and branch pulmonary arteries (70% vs. 36%, P=0.02).”
- Also stated in: § Epicardial echocardiography findings · plain
“Rates of visualization of the relevant anatomy were higher for on-protocol patients, though this only reached statistical significance for the DKS and the branch pulmonary arteries (Fig 1).”
- Also stated in: § DISCUSSION · plain
“Visualization of the DKS anastomosis and branch pulmonary arteries was significantly higher in the on-protocol cohort.”
Quote in the paperSubstantial claim - Also stated in: § Epicardial echocardiography findings · plain
- Findingown data
Two on-protocol patients with pulmonary artery stenosis on epicardial echocardiography did not have significant pulmonary artery stenosis on follow-up examination.
“Conversely, 2 patients in the on-protocol cohort who had pulmonary artery stenosis identified on the e-echo were not found to have significant pulmonary artery stenosis on follow-up examination.”
Quote in the paperSubstantial claim - Findingown data
Epicardial echocardiography identified residual lesions in 3 pre-protocol patients (10%) and 4 on-protocol patients (13%).
“Residual lesions were noted by e-echo in 3 (10%) of pre-protocol and 4 (13%) of on-protocol patients.”
- Also stated in: § DISCUSSION · plain
“In this investigation, residual lesions were noted by e-echo in 3 (10%) of pre-protocol and 4 (13%) of on-protocol patients.”
Quote in the paperSubstantial claim - Also stated in: § DISCUSSION · plain
- Findingown data
Rates of reintervention during the Stage 1 Norwood palliation hospitalization did not differ significantly between groups (6 pre-protocol [20%] vs. 3 on-protocol [10%], P=0.47).
“In total, 6 (20%) pre-protocol patients and 3 (10%) on-protocol patients underwent postoperative reintervention during the S1NP hospitalization (P=0.47).”
- Also stated in: § Results · plain
“Technical performance, rates of reintervention and clinical outcomes were not significantly different between the two groups.”
Quote in the paperSubstantial claim - Also stated in: § Results · plain
- Findingown data
Technical performance scores at discharge did not differ significantly between the pre-protocol and on-protocol groups.
“Technical performance, rates of reintervention and clinical outcomes were not significantly different between the two groups.”
- Also stated in: § Post-operative and follow-up data · plain
“Data pertaining to the postoperative clinical course was not significantly different between groups, nor were discharge technical performance scores (Table 3).”
- Also stated in: § DISCUSSION · plain
“Clinical outcomes, as measured by S1NP hospital course, technical performance scores, reintervention rates, and survival were not significantly different between the two cohorts.”
Quote in the paperNot a substantial claim - Also stated in: § Post-operative and follow-up data · plain
- Findingown data
No complications from epicardial echocardiography were reported in either cohort.
“No complications related to the e-echo were reported in either group.”
Quote in the paperNot a substantial claim - Findingown data
Of the remaining six lesions in both cohorts, only two required postoperative or interstage reintervention because they were clinically significant.
“Of the remaining 6 lesions in both cohorts, only 2 turned out to be clinically significant enough to require post-operative or interstage reintervention.”
Quote in the paperSubstantial claim - Findingown data
Visualization of the Damus-Kaye-Stansel anastomosis was significantly more frequent in the on-protocol cohort than in the pre-protocol cohort (93% vs. 68%, P=0.03).
“Compared with pre-protocol, visualization of the relevant anatomy was significantly increased for the Damus-Kaye-Stansel anastomoses (93% vs. 68% P=0.03) and branch pulmonary arteries (70% vs. 36%, P=0.02).”
- Also stated in: § Epicardial echocardiography findings · plain
“Rates of visualization of the relevant anatomy were higher for on-protocol patients, though this only reached statistical significance for the DKS and the branch pulmonary arteries (Fig 1).”
- Also stated in: § DISCUSSION · plain
“Visualization of the DKS anastomosis and branch pulmonary arteries was significantly higher in the on-protocol cohort.”
Quote in the paperSubstantial claim - Also stated in: § Epicardial echocardiography findings · plain
- Interpretationown data
Even when the repair appears optimal on intraoperative epicardial echocardiography, undiagnosed residual lesions may still be present.
“These data suggest that even if the repair is judged to be optimal on the intraoperative e-echo, undiagnosed residual lesions may still be present.”
Quote in the paperSubstantial claim - Premisecitation
Recent evidence indicates that immediate reintervention for residual lesions leads to better outcomes than reoperation later in the postoperative period.
“Recent data suggests that immediate reintervention on residual lesions is associated with improved outcomes compared to reoperation in the postoperative period.20”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [20] Newburger, 2014, Transplantation-free survival and interventions at 3 years in the single ventricle reconstruction trial, Circulation. source
Not checked in the free run.
- Study design and conductreasoning
The sample size was insufficient to detect differences in clinical outcomes.
“This is not surprising as the study was not powered to detect differences in clinical outcomes.”
- Also stated in: § DISCUSSION · plain
“A difference in technical performance scores or clinical outcomes was not appreciated in this cohort, though was not expected given the sample size.”
Quote in the paperSubstantial claim - Also stated in: § DISCUSSION · plain
- Premisecitation
Patients with better technical performance scores have been shown to have improved clinical outcomes.
“Patients with superior technical performance scores have more favorable outcomes.”
- Also stated in: § INTRODUCTION · boosted
“Patient with superior technical performance scores have been demonstrated to have improved clinical outcomes.16, 17”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [16] Bacha, 2008, Measurement of technical performance in surgery for congenital heart disease: the stage I Norwood procedure, J Thorac Cardiovasc Surg. source
Not checked in the free run.
- cites [17] Karamichalis, 2010, Stage I Norwood: optimal technical performance improves outcomes irrespective of preoperative physiologic status or case complexity, J Thorac Cardiovasc Surg. source
Not checked in the free run.
- Also stated in: § INTRODUCTION · boosted
- Interpretationreasoning
To demonstrate a clinical difference in technical performance or patient outcomes, performing epicardial echocardiography alone is not enough; intraoperative reintervention must also be performed.
“Also, in order for a clinical difference in technical performance or patient outcomes to be demonstrated, simply performing an e-echo is insufficient. Action, in the form of intraoperative reintervention, must be taken in order to alter a patient’s clinical course.”
Quote in the paperSubstantial claim - Interpretationown data
It is the standardization of the approach and adherence to a protocol that increases visualization rates.
“Rather, we aimed to convey that it is the standardization of the approach, and following of a protocol, that increases rates of visualization.”
Quote in the paperSubstantial claim - Interpretationreasoning
To the authors' knowledge, this is the first study focused exclusively on intraoperative imaging for Stage 1 Norwood palliation.
“To our knowledge ours is the first investigation to focus solely on intraoperative imaging for S1NP.”
Quote in the paperNot a substantial claim- Rests on an assumption: Whether intraoperative epicardial echocardiography can adequately image the relevant anatomy and how its findings relate to outcomes remain unknown.
- Interpretationown data
A standardized approach to intraoperative epicardial echocardiography can successfully visualize most of the relevant anatomy.
“These data suggest a standardized approach to the intraoperative e-echo can result in successful visualization of the majority of the relevant anatomy.”
Quote in the paperSubstantial claim - Interpretationown data
Finding a potential residual lesion on epicardial echocardiography may not by itself justify an immediate return to cardiopulmonary bypass.
“This suggests that simply identifying a potential residual lesion on e-echo may not be sufficient to require an immediate return to cardiopulmonary bypass.”
Quote in the paperSubstantial claim - Premisecitation
Few data have been published on intraoperative echocardiography for Stage 1 Norwood palliation.
“Little data on intraoperative echo for S1NP has been published.”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [12] Dragulescu, 2012, The impact of additional epicardial imaging to transesophageal echocardiography on intraoperative detection of residual lesions in congenital heart surgery, J Thorac Cardiovasc Surg. source
Not checked in the free run.
- cites [21] Nathan, 2014, Outcomes differ in patients who undergo immediate intraoperative revision versus patients with delayed postoperative revision of residual lesions in congenital heart operations, J Thorac Cardiovasc Surg. source
Not checked in the free run.
- cites [22] Smallhorn, 2002, Intraoperative transesophageal echocardiography in congenital heart disease, Echocardiography. source
Not checked in the free run.
- Study design and conductown data
The duration of cardiopulmonary bypass was similar in the two cohorts.
“Cardiopulmonary bypass times did not differ between the two groups.”
Quote in the paperNot a substantial claim - Premisecitation
Reinterventions after Stage 1 Norwood palliation are frequently due to recurrent or residual lesions that were addressed during surgery, mainly obstruction of the aortic arch and of the shunt or pulmonary arteries.
“In addition, reinterventions after S1NP are often related to recurrent or residual lesions that were addressed at the time of surgery, primarily aortic arch obstruction and shunt or pulmonary artery obstruction.13, 18, 19”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [13] Balmer, 2006, Experience with intraoperative ultrasound in paediatric cardiac surgery, Cardiol Young. source
Not checked in the free run.
- cites [18] Nathan, 2014, Technical performance score is associated with outcomes after the Norwood procedure, J Thorac Cardiovasc Surg. source
Not checked in the free run.
- cites [19] Hill, 2013, Intervention for recoarctation in the single ventricle reconstruction trial: incidence, risk, and outcomes, Circulation. source
Not checked in the free run.
- Premisecitation
Stage 1 Norwood palliation for single-ventricle heart disease is among the highest-risk operations in congenital cardiac surgery.
“Stage 1 Norwood palliation is one of the highest risk procedures in congenital cardiac surgery.”
- Also stated in: § INTRODUCTION · plain
“Stage 1 Norwood palliation (S1NP) for single ventricle heart disease remains one of the highest risk procedures in congenital heart surgery.13, 14”
Quote in the paperNot a substantial claim0 of 2 sources checked - Also stated in: § INTRODUCTION · plain
- May combine two claims. 8
- Classified as probably not a substantial claim. 5
May combine two claims.
Findingown dataAn epicardial echocardiogram was performed in 22 of 30 pre-protocol patients (73%) and all 30 on-protocol patients (100%), with a significant difference (P=0.005).
“An e-echo was performed in 22 (73%) pre-protocol and 30 (100%) on-protocol patients (P=0.005, Table 2).”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThese residual lesions led to a return to bypass in one pre-protocol patient and in no on-protocol patients.
“These residual lesions prompted a return to bypass in one pre-protocol patient and none of the on-protocol patients.”
- Also stated in: § Results · plain
“One residual lesion requiring immediate operative reintervention was diagnosed in the pre-protocol group.”
Quote in the paperSubstantial claim- Also stated in: § Results · plain
May combine two claims.
Findingown dataClinical outcomes, including interstage extracorporeal membrane oxygenator use, reinterventions, and survival, did not differ between the pre-protocol and on-protocol groups.
“Patients did not differ between groups with respect to interstage extracorporeal membrane oxygenator use, reinterventions, or survival (Fig 2).”
- Also stated in: § Results · plain
“Technical performance, rates of reintervention and clinical outcomes were not significantly different between the two groups.”
Quote in the paperSubstantial claim- Also stated in: § Results · plain
May combine two claims.
Findingown dataAmong residual lesions seen on intraoperative epicardial echocardiography that were not immediately treated, one pre-protocol patient (Damus-Kaye-Stansel obstruction) and one on-protocol patient (arch obstruction) later underwent reintervention during the Stage 1 Norwood palliation hospitalization or interstage period.
“Of the other residual lesions noted by intraoperative e-echo that were not immediately intervened on, 1 in the pre-protocol (DKS obstruction) and 1 in the on-protocol cohorts (arch obstruction) eventually underwent reintervention either in the post S1NP hospitalization or interstage period.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataIn the on-protocol cohort, the Damus-Kaye-Stansel anastomosis was seen in 93% and the proximal aortic arch in 90%.
“Within the on-protocol cohort, structures visualized with the greatest frequency, apart from ventricular and valvar function, were the DKS anastomosis (93%) and proximal aortic arch (90%).”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThe missed lesions were mainly related to the source of pulmonary blood flow and/or branch pulmonary arteries, although some involved the Damus-Kaye-Stansel anastomosis or aortic arch.
“These lesions were predominantly related to the source of pulmonary blood flow and/or branch pulmonary arteries, though some also involved the DKS or aortic arch.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductown dataThe pre-protocol and on-protocol cohorts were similar in baseline demographics, anatomy, comorbidities, and pre-Stage 1 Norwood palliation interventions.
“Patients in the pre-protocol (n=30) and on-protocol (n=30) cohorts were similar with respect to baseline demographics, anatomy, comorbidities, and pre-S1NP interventions (Table 1).”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationA surgical technical performance score has been created that relies mainly on imaging findings.
“A surgical technical performance score has been developed that is based predominantly on imaging findings.15”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [15] Shuhaiber, 2015, Survival outcomes following norwood procedure for hypoplastic left heart, Pediatr Cardiol. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIntraoperative echocardiography after cardiopulmonary bypass is routinely used to evaluate the surgical repair of congenital heart defects.
“Intraoperative post-cardiopulmonary bypass echocardiography (echo) is routinely performed to assess the surgical repair of congenital heart defects.1”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [1]
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationEpicardial 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”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [9] Schluter, 1982, Transoesophageal cross-sectional echocardiography with a phased array transducer system. Technique and initial clinical results, Br Heart J. source
Not checked in the free run.
- cites [10] Fontana, 1992, The surgeon's use of epicardial echocardiography during repair of congenital heart defects, Echocardiography. source
Not checked in the free run.
- cites [11] Muhiudeen, 1990, Intraoperative echocardiography in infants and children with congenital cardiac shunt lesions: transesophageal versus epicardial echocardiography, J Am Coll Cardiol. source
Not checked in the free run.
- cites [12] Dragulescu, 2012, The impact of additional epicardial imaging to transesophageal echocardiography on intraoperative detection of residual lesions in congenital heart surgery, J Thorac Cardiovasc Surg. source
Not checked in the free run.
Probably not a substantial claim: may not pass S4 (based).
InterpretationreasoningUsing a checklist of key images makes it less likely that important anatomic assessment is skipped or rushed.
“This observation is expected given that following a checklist of key images makes it less likely that assessment of important anatomic information is skipped or rushed through.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisereasoningThe authors chose epicardial echocardiography because of institutional preference, few miniaturized transesophageal transducers suitable for the smallest patients, and difficulty visualizing extracardiac or vascular anatomy via the transesophageal route.
“However, we chose to focus on e-echo in this report as it has been our institutional preference to perform e-echo for S1NP. This is primarily because of the limited availability of miniaturized transesophageal transducers for the smallest patients, and difficulties in imaging the extracardiac, or vascular anatomy by the transesophageal approach.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [23] Cannesson, 2008, Images in cardiovascular medicine. Intraoperative transesophageal echocardiography using a miniaturized transducer in a neonate undergoing Norwood procedure for hypoplastic left heart syndrome, Circulation. source
Not checked in the free run.
- cites [24] Hascoët, 2014, Safety and efficiency of the new micro-multiplane transoesophageal probe in paediatric cardiology, Arch Cardiovasc Dis. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe first author attended most operations to ensure adherence to the protocol.
“Finally, the first author was personally present at the majority of operations to ensure protocol adherence.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
Whether intraoperative epicardial echocardiography can adequately image the relevant anatomy and how its findings relate to outcomes remain unknown.
“The ability of intraoperative epicardial echocardiography to visualize the relevant anatomy and its association with outcomes is not known.”
The paper relies on this without support.
The authors assume that using epicardial echocardiography during surgery could let the surgeon correct leftover lesions before closing, potentially improving technical performance.
“Intraoperative epicardial echocardiography may allow the surgeon to address residual lesions prior to leaving the operating room, resulting in improved technical performance.”
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“Follow-up data included interstage events, reinterventions and pre-bidirectional Glenn technical performance score.(15) A consecutive cohort of 30 patients undergoing S1NP prior to implementation of the standardized protocol was used as an historical control.”
MethodInfluentialSelf-citationTechnical performance score is associated with outcomes after the Norwood procedure
Nathan, M., Sleeper, L. A., Ohye, R. G., Frommelt, P. C., Caldarone, C. A., Tweddell, J. S., Lu, M., Pearson, G. D., Gaynor, J. W., Pizarro, C., et al. (2014) · The Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2014.05.076 · Cited by 54 · cited 1× · see citing works
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“Recent data suggests that immediate reintervention on residual lesions is associated with improved outcomes compared to reoperation in the postoperative period.(20) While e-echo has been frequently utilized at our institution to assess S1NP, it has not been performed in a standardized fashion.”
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“Stage 1 Norwood palliation (S1NP) for single ventricle heart disease remains one of the highest risk procedures in congenital heart surgery.(13,14) A surgical technical performance score has been developed that is based predominantly on imaging findings.”
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Epicardial Echocardiography in Pediatric and Congenital Heart Surgery
Stern, K. W. D., Emani, S. M., Peek, G. J., Geva, T., & Kutty, S. (2019) · World Journal for Pediatric and Congenital Heart Surgery · doi:10.1177/2150135119838414 · Cited by 27 · see citing works
Self-citationThe role of intraoperative epicardial echocardiography in pediatric cardiac surgery
Öztürk, E., Tanıdır, İ. C., Ayyıldız, P., Gökalp, S., Kafali, H. C., Şahin, M., Ergül, Y., Haydın, S., & Güzeltaş, A. (2018) · Echocardiography · doi:10.1111/echo.13874 · Cited by 14 · see citing works
“IEE might be an effective alternative to TEE,3,9,10 particularly in the following cases: (1) where use of the TEE is impractical due to low body weight, micrognathia, macroglossia, or other such conditions; (2) where visualization with TEE is either difficult or insufficient (such as in the evaluation of the pulmonary…”
BackgroundNoninvasive Imaging in Interventional Cardiology: Hypoplastic Left Heart Syndrome
Bellsham‐Revell, H. (2021) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2021.637838 · Cited by 10 · see citing works
“Many patients may have epicardial (16) or transesophageal echocardiography (17, 18) in the operating theater, and if there are concerns either on the echocardiogram of with the patients’ hemodynamics, then there should be a low threshold for diagnostic”
BackgroundApplication of the Boston Technical Performance Score to intraoperative echocardiography
Bellsham‐Revell, H., Deri, A., Caroli, S., Durward, A., Miller, O., Mathur, S., Saundankar, J., Anderson, D. R., Austin, B. C., Salih, C., et al. (2019) · Echo Research and Practice · doi:10.1530/erp-19-0032 · Cited by 5 · see citing works
Wilson, H. C., Ferguson, M. E., Border, W. L., & Sachdeva, R. (2023) · Cardiology in the Young · doi:10.1017/s1047951123003633
Perioperative Imaging for the Pediatric Congenital Cardiac Patient
Satou, G. M., & Sklansky, M. (2023) · Springer eBooks · doi:10.1007/978-3-031-10442-8_6
Transesophageal and Intraoperative Echocardiography
Miller, O., & Simpson, J. M. (2021) · doi:10.1002/9781119612858.ch42
- Authors
- Stern, K. W. D., Gauvreau, K., Emani, S., & Geva, T.
- Affiliations
- Boston Children's Hospital (US)
- Corresponding author
- Stern, Kenan W.D.
- Venue
- Congenital Heart Disease
- Publisher
- Tech Science Press
- Published
- 2017-02-16
- Volume
- 12
- Issue
- 3
- Pages
- 350-356
- ISSN
- 1747-079X (ISSN-L)
- PMC
- PMC5459618
- OpenAlex
- W2588976388
- Cited by
- 7
- References
- 24
- Citations by year
- 2023: 2 · 2021: 2 · 2019: 2 · 2018: 1
- FWCI
- 0.64
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Congenital Heart Disease (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Higgins Family Noninvasive Research Fund
- National Institutes of Health (2 T32 HL007572-27 A1)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiovascular Conditions and Treatments
- Keywords
- congenital heart surgery, residual lesions, reintervention, technical performance, standardized imaging protocol
- MeSH terms
- Cardiopulmonary Bypass, Echocardiography, Feasibility Studies, Female, Heart Defects, Congenital, Humans, Infant, Newborn, Intraoperative Period, Male, Palliative Care, Pericardium, Reproducibility of Results, Norwood Procedures
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