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

Published online by Cambridge University Press:  02 March 2015

Erin J. Madriago ,
Rajesh Punn ,
Natalie Geeter  and
Norman H. Silverman
Erin J. Madriago*
Affiliation:
Department of Pediatric Cardiology, Oregon Health & Science University, Doernbecher Children’s Hospital, Portland, Oregon, United States of America Department of Pediatric Cardiology, Stanford University, Lucile Packard Children’s Hospital, Palo Alto, California, United States of America
Rajesh Punn
Affiliation:
Department of Pediatric Cardiology, Stanford University, Lucile Packard Children’s Hospital, Palo Alto, California, United States of America
Natalie Geeter
Affiliation:
Department of Pediatric Cardiology, Stanford University, Lucile Packard Children’s Hospital, Palo Alto, California, United States of America
Norman H. Silverman
Affiliation:
Department of Pediatric Cardiology, Stanford University, Lucile Packard Children’s Hospital, Palo Alto, California, United States of America
*
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: madriago@ohsu.edu
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Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Residual abnormalitiescardiopulmonary bypasspediatric imaging
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 2 , February 2016 , pp. 263 - 268
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Copyright
© Cambridge University Press 2015 

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