Usefulness of intraoperative transesophageal echocardiography in the assessment of surgical repair of pediatric ventricular septal defects with video-assisted endoscopic techniques in children.
BACKGROUND
Mini cardiac operative procedures with video-assisted endoscopic techniques for closure of ventricular septal defects (VSDs) in pediatric patients have become quite popular for cardiac surgery. A precise diagnosis is very important for determining the surgical approach, and evaluation by intraoperative transesophageal echocardiography (TEE) plays a major role in confirmation of the preoperative diagnosis, residual defects, and the need to return to the bypass after repair.


METHODS
Sixty-five patients (30 boys and 35 girls; aged 8.7 +/- 5.3 years) who were undergoing minimally invasive closure of VSDs were monitored with a Hewlett-Packard color Doppler pediatric TEE throughout the procedure.


RESULTS
Closure of the defect was successfully performed in all patients. Sixty-two patients showed neither residual shunt nor aortic regurgitation after the repair. Residual leaks were detected intraoperatively in 3 patients after the repair. One patient required a return to the bypass with an immediate reoperation due to a residual color jet diameter of > 3 mm. One patient was changed from video-assisted endoscopic techniques to a surgical approach for closure of the VSD from a conventional median sternotomy after identification by TEE of an outlet-type perimembranous VSD with 2 additional muscular VSDs.


CONCLUSIONS
Our study showed that, with refinement of surgical closure of VSD via video-assisted endoscopic techniques, intraoperative TEE provides valuable and accurate information for decision-making in surgical management, provides immediate assessment of surgical repairs, and prevents reintervention and the morbidity associated with residual flow.
Ho
Angie C Y
AC
Department of Anesthesiology, Chang Gung Memorial Hospital, 5, Fushing Street, Gueishan Shiang, Taoyuan, Taiwan 333, ROC. hocy@cgmh.org.tw
Chen
Chong-Kwai
CK
Yang
Min-Wen
MW
Chu
Jaw-Ji
JJ
Lin
Pyng-Jing
PJ
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D007223:Infant; D007430:Intraoperative Care; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D015203:Reproducibility of Results; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome