Intraoperative echocardiography during congenital heart operations: experience from 1,000 cases.
BACKGROUND
This article provides an overview of the application of intraoperative echocardiography during repair of congenital heart defects based on our experience with 1,000 patients.


METHODS
The patients in this study all underwent repair of a congenital heart defect between 1987 and 1994 at Duke University Medical Center. Echocardiography was performed on all patients in the operating room both before and after repair using epicardial or transesophageal imaging (or both). Hospital costs and outcome data were obtained for all patients.


RESULTS
Overall, 44 patients (4.4%) underwent intraoperative revision of their repair based on echocardiographic findings. There was an initial learning phase during which 8.5% of repairs needed to be revised. With experience, the number of revisions fell to as low as 3% to 4%, but need for revision continued to occur throughout the series. Thirty-nine patients (88.6%) had a successful revision. It was not possible for the surgeon to predict the need for a revision based on his confidence in the repair: in 2.6% of patients thought by the surgeon to have a good repair, intraoperative echocardiography revealed the need for operative revision. The average cost for patients who return to the operating room during their hospitalization for revision of a repair is significantly greater than for those whose repairs are revised before they leave the operating room ($94,180.28 +/- $33,881.63 versus $21,415.79 +/- $8,215.74). There were no significant complication attributable to intraoperative echocardiography.


CONCLUSIONS
In an era where complete repair of congenital heart defects is emphasized, intraoperative echocardiography provides information that can guide successful operative revision so that babies leave the operating room with optimal results.
Ungerleider
R M
RM
Department of Surgery, Duke University Medical Center, Durham, North Carolina 27712, USA.
Kisslo
J A
JA
Greeley
W J
WJ
Li
J S
JS
Kanter
R J
RJ
Kern
F H
FH
Schulman
S R
SR
Nesmith
J W
JW
Gaynor
J W
JW
Bengur
A R
AR
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000191:economics / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007432:Intraoperative Period; D008875:Middle Aged; D012086:Reoperation; D016896:Treatment Outcome