Intraoperative transoesophageal echocardiography in a low birth weight neonate with atrioventricular septal defect.
An 18-day-old male neonate (45 cm, 1.8 kg) with a history of cyanosis and congestive heart failure from an atrioventricular septal defect (AVSD) with a large left-to-right shunt was scheduled for surgical repair of the AVSD. After routine induction of anaesthesia with fentanyl and vecuronium, a 4.5-mm diameter transoesophageal echocardiography (TOE) probe was inserted into the oesophagus, and systematic echocardiographic evaluation was performed during surgery. After cardiopulmonary bypass was stopped, intraoperative TOE revealed mild residual mitral valve regurgitation. Because good left ventricular wall motion was confirmed and haemodynamic parameters were stable, cardiopulmonary bypass was not reinitiated. The patient's cardiac output was low in the postoperative intensive care unit. TOE was performed the next day to detect the source of this problem, revealed severe regurgitation compared with that observed intraoperatively. TOE was useful for evaluation of the residual mitral valve regurgitation, and we reconfirmed the importance of continuous monitoring even in a low birthweight neonate undergoing repair of a complete AVSD.
Kawahito
Shinji
S
Department of Anesthesiology, Tokushima University School of Medicine, Tokushima, Japan. kawahito@clin.med.tokushima-u.ac.jp
Kitahata
Hiroshi
H
Tanaka
Katsuya
K
Nozaki
Junpei
J
Oshita
Shuzo
S
D017548:Echocardiography, Transesophageal / Q000379:methods*; D017809:Fatal Outcome; D006325:Heart Atria / Q000000981:diagnostic imaging; D006343:Heart Septal Defects / Q000000981:diagnostic imaging* / Q000601:surgery*; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging; D016343:Monitoring, Intraoperative / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging