Routine use of intraoperative epicardial echocardiography and Doppler color flow imaging to guide and evaluate repair of congenital heart lesions. A prospective study.
Routine epicardial two-dimensional echocardiography, Doppler, and Doppler color flow imaging studies were performed before and after cardiopulmonary bypass in 328 patients undergoing operations for congenital heart disease. Ages ranged from 1 day to 59 years (mean 5.9 years); the smallest patient was 1.8 kg. Complete examinations were conducted in 3.6 +/- 1.7 minutes. Prebypass examinations demonstrated previously unappreciated details of anatomy in 60 patients (18%), which did not relate to whether catheterization had been performed, and they were believed to play a role in surgical planning in 143 patients (44%). Discovery of previously unrecognized features of anatomy increased the impact of echo-Doppler color flow imaging on operative planning by 2.5 times. After bypass, echo-Doppler color flow imaging disclosed unsuspected residual defects in 22 patients (7%) who were doing well clinically and enabled an attempt at immediate revision of the procedure. When ultimate clinical outcome was compared to postbypass findings of echo-Doppler color flow imaging, the presence of a residual defect, right or left ventricular dysfunction, or any concern with the heart by echo-Doppler color flow imaging appeared to serve as a predictor of unfavorable outcome (p less than 0.001 for each when compared with absence of these difficulties). Thus routine intraoperative echo-Doppler color flow imaging is useful in aiding the planning, conduct, and assessment of results in operations for congenital heart disease.
Ungerleider
R M
RM
Department of Surgery, Duke University Medical Center, Durham, N.C. 27710.
Greeley
W J
WJ
Sheikh
K H
KH
Philips
J
J
Pearce
F B
FB
Kern
F H
FH
Kisslo
J A
JA
D002315:Cardiopulmonary Bypass; D002675:Child, Preschool; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D011446:Prospective Studies; D012086:Reoperation; D013997:Time Factors