Routine intra-operative trans-oesophageal echocardiography yields better outcomes in surgical repair of CHD.
OBJECTIVE
Trans-oesophageal echocardiographic imaging is valuable in the pre- and post-operative evaluation of children and adults with CHD; however, the frequency by which trans-oesophageal echocardiography guides the intra-operative course of patients is unknown.


METHODS
We retrospectively reviewed 1748 intra-operative trans-oesophageal echocardiograms performed between 1 October, 2005 and 31 December, 2010, and found 99 cases (5.7%) that required return to bypass, based in part upon the intra-operative echocardiographic findings.


RESULTS
The diagnoses most commonly requiring further repair and subsequent imaging were mitral valve disease (20.9%), tricuspid valve disease (16.0%), atrioventricular canal defects (12.0%), and pulmonary valve disease (14.1%). The vast majority of those requiring immediate return to bypass benefited by avoiding subsequent operations and longer lengths of hospital stay. A total of 14 patients (0.8%) who received routine imaging required further surgical repair within 1 week, usually due to disease that developed over ensuing days. Patients who had second post-operative trans-oesophageal echocardiograms in the operating room rarely required re-operations, confirming the benefit of routine intra-operative imaging.


CONCLUSIONS
This study represents a large single institutional review of intra-operative trans-oesophageal echocardiography, and confirms its applicability in the surgical repair of patients with CHD. Routine imaging accurately identifies patients requiring further intervention, does not confer additional risk of mortality or prolonged length of hospital stay, and prevents subsequent operations and associated sequelae in a substantial subset of patients. This study demonstrates the utility of echocardiography in intra-operative monitoring of surgical repair and highlights patients who are most likely to require return to bypass, as well as the co-morbidities of such manipulations.
1Department of Pediatric Cardiology,Oregon Health & Science University,Doernbecher Children's Hospital,Portland,Oregon,United States of America.
Erin J
EJ
Madriago
2Department of Pediatric Cardiology,Stanford University,Lucile Packard Children's Hospital,Palo Alto,California,United States of America.
Rajesh
R
Punn
2Department of Pediatric Cardiology,Stanford University,Lucile Packard Children's Hospital,Palo Alto,California,United States of America.
Natalie
N
Geeter
2Department of Pediatric Cardiology,Stanford University,Lucile Packard Children's Hospital,Palo Alto,California,United States of America.
Norman H
NH
Silverman
D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D055815:Young Adult
Residual abnormalities; cardiopulmonary bypass; pediatric imaging