The Significance of Transesophageal Echocardiography in Assessing Congenital Heart Disease: Our Experience

Abstract

The use of intraoperative TEE in surgical centers for congenital heart disease allows for a significant reduction in mortality and morbidity. Intraoperative TEE performed by experienced pediatric cardiologists is therefore an absolute necessity.

The role of intraoperative epicardial echocardiography in pediatric cardiac surgery

“…As TEE is performed under general anesthesia and requires the probe in the esophagus, some complications may develop . Although Randolph et al reported a 1% rate of minor complications and no major complications in their study, Iwasaki et al found 3 respiratory and 9 significant hemodynamic complications in a total of 773 patients.…”

“…Intraoperative imaging modalities help postoperative intensive care unit management of patients by delineating residual lesions, cardiac function, and hemodynamic changes during and immediately after surgical procedures. This, in turn, has resulted to an increase in the need for intraoperative echocardiography (transesophageal or epicardial), especially during congenital heart surgery …”

“…Intraoperative use is currently the most common indication of transesophageal echocardiography (TEE) in the pediatric age group. Numerous reports have documented the benefits of this approach, and the experience to date accounts for the incorporation of TEE into the standard care of patients undergoing surgery for congenital heart diseases (CHDs) in many centers worldwide …”

“…Numerous reports have documented the benefits of this approach, and the experience to date accounts for the incorporation of TEE into the standard care of patients undergoing surgery for congenital heart diseases (CHDs) in many centers worldwide. 1,2 However, inappropriate probe size for newborns and infants, inappropriate anatomy of the jaw, macroglossia, and potential procedural complications (eg, esophageal trauma, arrhythmia) limit TEE application. Intraoperative epicardial echocardiography (IEE) might be a simple but effective alternative to TEE.…”

Intraoperative Transesophageal Echocardiography: Review and Evolution

“…Before surgical correction, TEE confirms diagnosis and after surgical repair assesses correct fix and detects remaining lesions. A recent study showed that in almost 6,5% of the patients undergoing surgery for congenital heart disease (CHD), iTEE changed surgical plan and allowed immediately repair of surgical abnormalities [42,43]. TEE is used in several different surgical procedures in CHD such atrial septal defect (ASD), ventricular septal defect (VSD), valve replacement, atrioventricular canal, combined ASD and VSD or combined VSD and pulmonary stenosis, valve reconstruction, subaortic stenosis resection, reoperation and neo-natal surgery, Fontan procedure, Tetralogy of Fallot (TF), Ebstein anomaly and even in extracardiac procedures [42].…”