title: Predischarge Transthoracic Echocardiography after Surgery for Congenital Heart Disease: A Routine with a Reason?
abstract: BACKGROUND
  Predischarge (pre-d/c) transthoracic echocardiography (TTE) is routine after surgery for congenital heart disease, but how it affects clinical care is unknown. The aim of this study was to test the hypothesis that pre-d/c TTE frequently reveals findings associated with short-term clinical course through a systematic review of findings on pre-d/c TTE and clinical events that followed.
  
  
  METHODS
  Clinical outcomes of mortality, hospitalization, catheterization, and surgery at 1 year were examined for pediatric patients undergoing pre-d/c TTE between June 2010 and June 2012. Using logistic regression, a multivariate model was generated associating clinical, pre-d/c transthoracic echocardiographic, and demographic variables with unplanned postdischarge cardiac events (UCEs) within 1 year.
  
  
  RESULTS
  Of 462 patients who underwent pre-d/c TTE, there were 265 male patients (57%) and 197 female patients (43%); the median age was 0.8 years (range, 0-33 years). Two hundred thirty-seven patients (51%) had findings (valve regurgitation, hemodynamic obstruction, ventricular dysfunction, unintended shunt, or pericardial effusion) on pre-d/c TTE, 57 of which were of more than mild severity. Agreement between pre-d/c TTE and postoperative transesophageal echocardiographic findings was only fair to moderate (κ = 0.27-0.43). Sixty-four patients (14%) had UCEs. Univariate analysis revealed that UCE were more frequent in patients with diagnoses and surgical procedures of high complexity. After accounting for these confounding nonechocardiographic variables, pre-d/c transthoracic echocardiographic findings, specifically valve regurgitation of more than mild severity, and ventricular dysfunction and obstructions of any severity were independently associated with UCEs (odds ratios, 1.90, 1.99, and 1.85, respectively).
  
  
  CONCLUSIONS
  Findings on pre-d/c TTE are frequent, commonly discordant with postoperative transesophageal echocardiographic results, and associated with adverse clinical events after surgery for congenital heart disease. These data would strongly support the practice of pre-d/c TTE after surgery for congenital heart disease.
authors.affiliation: Division of Pediatric Cardiology, University of Nebraska College of Medicine and Children's Hospital and Medical Center, Omaha, Nebraska.
authors.forename: Irsa
authors.initials: I
authors.lastname: Shoiab
authors.affiliation: Division of Pediatric Cardiology, University of Nebraska College of Medicine and Children's Hospital and Medical Center, Omaha, Nebraska.
authors.forename: David A
authors.initials: DA
authors.lastname: Danford
authors.affiliation: Division of Pediatric Cardiology, University of Nebraska College of Medicine and Children's Hospital and Medical Center, Omaha, Nebraska.
authors.forename: Ling
authors.initials: L
authors.lastname: Li
authors.affiliation: Division of Pediatric Cardiovascular Surgery, University of Nebraska College of Medicine and Children's Hospital and Medical Center, Omaha, Nebraska.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Abdullah
authors.affiliation: Division of Pediatric Cardiovascular Surgery, University of Nebraska College of Medicine and Children's Hospital and Medical Center, Omaha, Nebraska.
authors.forename: James M
authors.initials: JM
authors.lastname: Hammel
authors.affiliation: Division of Pediatric Cardiology, University of Nebraska College of Medicine and Children's Hospital and Medical Center, Omaha, Nebraska. Electronic address: skutty@unmc.edu.
authors.forename: Shelby
authors.initials: S
authors.lastname: Kutty
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010351:Patient Discharge; D011184:Postoperative Period; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: Congenital heart disease; Outcomes after surgery; Predismissal echocardiography; Two-dimensional echocardiography