title: Usefulness of intra-operative epicardial three-dimensional echocardiography to guide aortic valve repair in children.
abstract: The aim of this study was to determine the additional important information obtained on prebypass epicardial 3-dimensional imaging (E-3D) compared with transesophageal 2-dimensional echocardiography (TEE-2D) in young patients who undergoing aortic valve repair. From January 2004 to May 2007, all patients who underwent reconstructive surgery of the native aortic valve and intraoperative TEE-2D and E-3D were retrospectively reviewed. Thirteen structural anatomic variables of the aortic valve for TEE-2D and E-3D were evaluated, scored, and compared (by a blinded observer) with intraoperative surgical findings. Nineteen patients underwent valve repair. The median age at surgery was 10 years (range 1 day to 24 years). The primary aortic valve disease was regurgitation (n = 19), and 2 patients had additional valvar stenosis. TEE-2D and E-3D were able to detect 82% (n = 204) and 91% (n = 225), respectively, of the intraoperative findings (n = 247) (p = 0.006). Individual evaluation scores were higher for E-3D (median 12, interquartile range 11 to 13) than for TEE-2D (median 11, interquartile range 10 to 12) (p = 0.01) compared with surgical findings (score 13). Differences in detection sensitivity occurred for commissural fusion (n = 7), leaflet perforation or deficiency (n = 5), and leaflet prolapse (n = 2). TEE-2D was more likely to have false-negative findings than E-3D (36 vs 16 findings, p = 0.001). In conclusion, intraoperative E-3D provides additional important information over TEE-2D for aortic valve repair in young patients. Such 3-dimensional echocardiographic imaging has become an important intraoperative modality for valve repair at the investigators' institution.
authors.affiliation: Department of Cardiac Surgery, Children's Hospital Boston, Boston, MA, USA.
authors.forename: Vladimiro L
authors.initials: VL
authors.lastname: Vida
authors.forename: Renè
authors.initials: R
authors.lastname: Hoehn
authors.forename: Luis Alesandro
authors.initials: LA
authors.lastname: Larrazabal
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.forename: Gerald R
authors.initials: GR
authors.lastname: Marx
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: del Nido
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D002648:Child; D004452:Echocardiography; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D012189:Retrospective Studies