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Routine intra-operative trans-oesophageal echocardiography yields better outcomes in surgical repair of CHD

  • Erin J. Madriago (a1) (a2), Rajesh Punn (a2), Natalie Geeter (a2) and Norman H. Silverman (a2)



Trans-oesophageal echocardiographic imaging is valuable in the pre- and post-operative evaluation of children and adults with CHD; however, the frequency by which trans-oesophageal echocardiography guides the intra-operative course of patients is unknown.


We retrospectively reviewed 1748 intra-operative trans-oesophageal echocardiograms performed between 1 October, 2005 and 31 December, 2010, and found 99 cases (5.7%) that required return to bypass, based in part upon the intra-operative echocardiographic findings.


The diagnoses most commonly requiring further repair and subsequent imaging were mitral valve disease (20.9%), tricuspid valve disease (16.0%), atrioventricular canal defects (12.0%), and pulmonary valve disease (14.1%). The vast majority of those requiring immediate return to bypass benefited by avoiding subsequent operations and longer lengths of hospital stay. A total of 14 patients (0.8%) who received routine imaging required further surgical repair within 1 week, usually due to disease that developed over ensuing days. Patients who had second post-operative trans-oesophageal echocardiograms in the operating room rarely required re-operations, confirming the benefit of routine intra-operative imaging.


This study represents a large single institutional review of intra-operative trans-oesophageal echocardiography, and confirms its applicability in the surgical repair of patients with CHD. Routine imaging accurately identifies patients requiring further intervention, does not confer additional risk of mortality or prolonged length of hospital stay, and prevents subsequent operations and associated sequelae in a substantial subset of patients. This study demonstrates the utility of echocardiography in intra-operative monitoring of surgical repair and highlights patients who are most likely to require return to bypass, as well as the co-morbidities of such manipulations.


Corresponding author

Correspondence to: Dr E. J. Madriago, MD, Division of Pediatric Cardiology, 707 SW Gaines Street, CDRC-P, Portland, OR 97239, United States of America. Tel: +503 494 2783; Fax: +503 494 2824; E-mail:


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1. Bettex, DA, Schmidlin, D, Bernath, MA, et al. Intraoperative transesophageal echocardiography in pediatric congenital cardiac surgery: a two-center observational study. Anesth Analg 2003; 97: 12751282.
2. Ritter, SB. Transesophageal echocardiography in children: new peephole to the heart. J Am Coll Cardiol 1990; 16: 447450.
3. Muhiudeen, IA, Roberson, DA, Silverman, NH, Haas, GS, Turley, K, Cahalan, MK. Intraoperative echocardiography for evaluation of congenital heart defects in infants and children. Anesthesiology 1992; 76: 165172.
4. Lowe, HJ, Ferris, TA, Hernandez, PM, Weber, SC. STRIDE–An integrated standards-based translational research informatics platform. AMIA Annu Symp Proc 2009; 2009: 391395.
5. Stevenson, JG, Sorensen, GK, Gartman, DM, Hall, DG, Rittenhouse, EA. Transesophageal echocardiography during repair of congenital cardiac defects: identification of residual problems necessitating reoperation. J Am Soc Echocardiogr 1993; 6: 356365.
6. Daniel, WG, Erbel, R, Kasper, W, et al. Safety of transesophageal echocardiography. A multicenter survey of 10,419 examinations. Circulation 1991; 83: 817821.
7. Bengur, AR, Li, JS, Herlong, JR, Jaggers, J, Sanders, SP, Ungerleider, RM. Intraoperative transesophageal echocardiography in congenital heart disease. Semin Thorac Cardiovasc Surg 1998; 10: 255264.
8. Peng, DM, Sun, HY, Hanley, FL, Olson, I, Punn, R. Coronary sinus obstruction after atrioventricular canal defect repair. Congenit Heart Dis 2014; 9: E1214.
9. Randolph, GR, Hagler, DJ, Connolly, HM, et al. Intraoperative transesophageal echocardiography during surgery for congenital heart defects. J Thorac Cardiovasc Surg 2002; 124: 11761182.
10. Ayres, NA, Miller-Hance, W, Fyfe, DA, et al. Indications and guidelines for performance of transesophageal echocardiography in the patient with pediatric acquired or congenital heart disease: report from the task force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr 2005; 18: 9198.
11. Guzeltas, A, Ozyilmaz, I, Tanidir, C, et al. The significance of transesophageal echocardiography in assessing congenital heart disease: our experience. Congenit Heart Dis 2014; 9: 300306.
12. Shanks, M, Delgado, V, Ng, AC, et al. Mitral valve morphology assessment: three-dimensional transesophageal echocardiography versus computed tomography. Ann Thorac Surg 2010; 90: 19221929.
13. Khaw, AV, von Bardeleben, RS, Strasser, C, et al. Direct measurement of left ventricular outflow tract by transthoracic real-time 3D-echocardiography increases accuracy in assessment of aortic valve stenosis. Int J Cardiol 2009; 136: 6471.



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