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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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References

Gussenhoven EJ, van Herwerden LA, Roeland J, Ligtvoet KM, Bos E, Witsenburg M. Intraoperative two-dimensional echocardiography in congenital heart disease. J Am Coll Cardiol 1987; 9: 565–572.Google Scholar
Bengur AR, Li JS, Herlong JR, Jaggers J, Sanders SP, Ungerleider RM. Intraoperative transoesophageal echocardiography in congenital heart disease. Semin Thorac Cardiovasc Surg 1998; 10: 255–264.Google Scholar
Sloth E, Pedersen J, Hjortholm Olsen K, Wanscher M, Kromann Hansen O, Sorensen KE. Transoesophageal echocardiographic monitoring during paediatric cardiac surgery: obtainable information and feasibility in 532 children. Paediatr Anaesth 2001; 11: 657–662.Google Scholar
Moran AM, Geva T. Con: Pediatric anesthesiologists should not be the primary echocardiographers for pediatric patients undergoing cardiac surgical procedures. J Cardiothorac Vasc Anesth 2001; 15: 391–393.Google Scholar
Nowrangi SK, Connoly HM, Freeman WK, Click RL. Impact of intraoperative transesophageal echocardiography among patients undergoing aortic valve replacement for aortic stenosis. J Am Soc Echocardiogr 2001; 14: 863–866.Google Scholar
Ungerleider RM, Greeley WJ, Kanter RJ, Kisslo JA. The learning curve for intraoperative echocardiography during congenital heart surgery. Ann Thorac Surg 1992; 54: 691–698.Google Scholar
Ungerleider RM, Kisslo JA, Greeley WJ, et al. Intraoperative echocardiography during congenital heart operations: experience from 1000 cases. Ann Thorac Surg 1995; 60: S539–S542.Google Scholar
Stevenson JG. Role of intraoperative transesophageal echocardiography during repair of congenital cardiac defects. Acta Paediatr Suppl 1995; 410: 23–33.Google Scholar
Siwik ES, Spector ML, Patel CR, Zahka KG. Cost and cost-effectiveness of routine transoesophageal echocardiography in congenital heart surgery. Am Heart J 1999; 138: 771–776.Google Scholar
Hsu YH, Santulli T, Wong AL, Drinkwater D, Lakas H, Williams RG. Impact of intraoperative echocardiography on surgical management of congenital heart disease. Am J Cardiol 1991; 67: 1279–1283.Google Scholar
Xu J, Shiota T, Ge S, et al. Intraoperative transoesophageal echocardiography using high-resolution biplane 7.5 MHz probes with continuous-wave Doppler capability in infants and children with tetralogy of fallot. Am J Cardiol 1996; 77: 539–542.Google Scholar
Ungerleider RM, Greeley WJ, Sheikh KH, Pearce FB, Kern FH, Kisslo JA. Routine use of intraoperative echocardiography and Doppler color flow imaging to guide and evaluate repair of congenital heart disease. J Thorac Cardiovasc Surg 1990; 100: 297–309.Google Scholar
Sreeram N, Kaulitz R, Stümper O, Hess J, Quaegebeur JM, Sutherland GR. Comparative roles of intraoperative epicardial and early postoperative transthoracic echocardiography in the assessment of surgical repair in congenital heart defects. J Am Coll Cardiol 1990; 16: 913–920.Google Scholar
O'Leary PW, Hagler DJ, Seward JB, et al. Biplane intraoperative transoesophageal echocardiography in congenital heart disease. Mayo Clin Proc 1995; 70: 317–326.Google Scholar
Stevenson JG. Incidence of complications in pediatric transoesophageal echocardiography: experience in 1650 cases. J Am Soc Echocardiogr 1999; 12: 527–532.Google Scholar
Muhiudeen IA, Roberson DA, Silverman NH, Haas G, Turley K, Cahalan MK. Intraoperative echocardiography in infants and children with congenital cardiac shunt lesions: transesophageal versus epicardial echocardiography. J Am Coll Cardiol 1990; 16: 1687–1695.Google Scholar
Sangwan S, Au C, Mahajan A. Pro: Pediatric anesthesiologists should be the primary echocardiographers for pediatric patients undergoing cardiac surgical procedures. J Cardiothorac Vasc Anesth 2001; 15: 388–390.Google Scholar
Fyfe D. Transesophageal echocardiography guidelines: return to bypass or bypass the guidelines? J Am Soc Echocardiogr 1999; 12: 343–344.Google Scholar
Russell IM, Silverman NH, Miller-Hance W, et al. Intraoperative transesophageal echocardiography for infants and children undergoing congenital heart surgery: the role of the anesthesiologist. J Am Soc Echocardiogr 1999; 12: 1009–1014.Google Scholar
Stevenson JG. Performance of intraoperative pediatric transesophageal echocardiography by anesthesiologists and echocardiographers: training and availability are more important than hats. J Am Soc Echocardiogr 1999; 12: 1013–1014.Google Scholar
Fyfe DA. Intraoperative transesophageal echocardiography in children with congenital heart disease: how, not who! J Am Soc Echocardiogr 1999; 12: 1011–1013.Google Scholar
Yang SG, Novello R, Nicolson S, et al. Evaluation of ventricular septal defect repair using intraoperative transesophageal echocardiography: frequency and significance of residual defects in infants and children. Echocardiography 2000; 17: 681–684.Google Scholar
Winlaw DS, McGuirk SP, Balmer C, et al. Intention-to-treat analysis of pulmonary artery banding in conditions with a morphologic right ventricle in the systemic circulation with a view to anatomic biventricular repair. Circulation 2005; 111: 405–411.Google Scholar
Kawahito S, Kitahata H, Tanaka K, Nozaki J, Oshita S. Intraoperative evaluation of pulmonary artery flow during the Fontan procedure by transesophageal Doppler echocardiography. Anesth Analg 2000; 91: 1375.Google Scholar
Fyfe DA, Kline CH, Sade RM, Greene CA, Gilette PC. The utility of transoesophageal echocardiography during and after Fontan operations in small children. Am Heart J 1991; 122: 1403–1415.Google Scholar
Stumper O, Sutherland GR, Sreeram N, et al. Role of intraoperative ultrasound examination in patients undergoing a Fontan-Type procedure. Br Heart J 1991; 65: 204–210.Google Scholar