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Experience with intraoperative ultrasound in paediatric cardiac surgery

Published online by Cambridge University Press:  20 September 2006

Christian Balmer ,
David Barron ,
John G.C. Wright ,
Joe V. de Giovanni ,
Paul Miller ,
Rami Dhillon ,
William J. Brawn  and
Oliver Stümper
Christian Balmer
Affiliation:
The Heart Unit, Birmingham Children's Hospital-NHS Trust, Birmingham, United Kingdom
David Barron
Affiliation:
The Heart Unit, Birmingham Children's Hospital-NHS Trust, Birmingham, United Kingdom
John G.C. Wright
Affiliation:
The Heart Unit, Birmingham Children's Hospital-NHS Trust, Birmingham, United Kingdom
Joe V. de Giovanni
Affiliation:
The Heart Unit, Birmingham Children's Hospital-NHS Trust, Birmingham, United Kingdom
Paul Miller
Affiliation:
The Heart Unit, Birmingham Children's Hospital-NHS Trust, Birmingham, United Kingdom
Rami Dhillon
Affiliation:
The Heart Unit, Birmingham Children's Hospital-NHS Trust, Birmingham, United Kingdom
William J. Brawn
Affiliation:
The Heart Unit, Birmingham Children's Hospital-NHS Trust, Birmingham, United Kingdom
Oliver Stümper
Affiliation:
The Heart Unit, Birmingham Children's Hospital-NHS Trust, Birmingham, United Kingdom
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Abstract

Objective: Intraoperative ultrasound was introduced to evaluate the adequacy of repair after surgical repair of congenital cardiac malformations. Our purpose was to review the evolution of this technique at our centre. Methods: We evaluated all intraoperative ultrasound studies undertaken between 1997 and 2002, reviewing the data from 1997 through 2001 retrospectively, but undertaking a prospective audit of studies undertaken from 2002 onwards. In all, we carried out a total number of 639 intraoperative ultrasound studies, from a possible 2737 cardiac operations (23.3%), using the epicardal approach in 580 (90.7%), and transoesophageal ultrasound in the other 59 patients (9.3%). Median age was 0.6 years, with an interquartile range from 0.06 to 3.6 years. Results: The findings obtained using intraoperative ultrasound influenced the surgical management in 63 of the 639 patients (9.9%), suggesting the need for additional surgery in 26, adjustment of the band placed round the pulmonary trunk in 16, preoperative assessment of the cardiac malformation in 5, and confirming the need for prolonged support with cardiopulmonary bypass for impaired ventricular function in 16. There were 18 early reoperations, 5 of which may have been predicted by intraoperative ultrasound. Of the 183 studies reviewed prospectively in 2002, it was not possible to obtain the complete range of views in 8 (4.4%), while in 27 patients (14.7%), the postoperative findings using transthoracic interrogation differed from the findings obtained immediately following bypass. Conclusion: Intraoperative ultrasound is an important technique for monitoring the results of complex congenital cardiac surgery. The immediate recognition of significant lesions, together with multidisciplinary discussion, allows for improved management and prevention of early surgical reintervention.

Keywords

Congenital cardiac malformationsepicardial ultrasoundtransoesophageal echocardiography
Type
Original Article
Information
Cardiology in the Young , Volume 16 , Issue 5 , October 2006 , pp. 455 - 462
Copyright
© 2006 Cambridge University Press

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