Key result
Intraoperative transoesophageal echocardiography confirmed preoperative diagnosis in 93% of cases and prompted return to bypass in 6 of 10 re-interventions, with probe insertion complications in 5.5%.
Why the study?
Does intraoperative transoesophageal echocardiography improve surgical management and detect residual defects in pediatric patients undergoing repair of congenital heart disease?
Observational (n=200)
Does intraoperative transoesophageal echocardiography improve surgical management and detect residual defects in pediatric patients undergoing repair of congenital heart disease?
Routine intraoperative TOE is highly effective for confirming diagnoses and detecting residual defects requiring immediate surgical revision in pediatric congenital heart surgery, though careful monitoring is required during probe insertion in small children.
Answers are grounded in this paper and cite their sources.
May support intraoperative TOE for residual defect detection in pediatric CHD surgery; leaves open need for prospective validation.
We report out initial experience with intraoperative transoesophageal echocardiography (TOE) in 200 patients undergoing repair of congenital heart disease. Complications associated with probe insertion precluded a full study in 11 patients (5.5%) and included airway obstruction (n = 6), inability to pass the probe (n = 4) and vascular compression (n = 1). The preoperative diagnosis was confirmed by TOE in 176 of 189 cases (93%) with minor variances in 12 (6.3%) and one major variance (additional large muscular ventricular septal defect (VSD)). Unexpected abnormalities not diagnosed preoperatively were found at surgery in four cases (2%) and were all of trivial operative significance. Postoperative studies showed no residual defect in 96 (51%) and trivial or mild residual defects in 72 patients (38%). There were moderate or severe residual defects in 21 cases (11%). Ten cases (5.3%) returned to bypass for further surgery, with eight achieving complete or adequate amelioration. In six of the 10 cases, return to bypass was prompted by the TOE examination alone. There was one re-operation in the postoperative period for a VSD patch dehiscence. Routine TOE offers significant advantages in the management of patients undergoing repair of congenital heart disease, particularly in postoperative assessment. Careful monitoring of perfusion and ventilation is required, particularly during probe insertion in children weighing 5 kg or less.
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Sheil et al. (1999) conducted an observational in Congenital heart disease (n=200). Intraoperative transoesophageal echocardiography (TOE) was evaluated on Confirmation of preoperative diagnosis. Intraoperative transoesophageal echocardiography confirmed preoperative diagnosis in 93% of cases and prompted return to bypass in 6 of 10 re-interventions, with probe insertion complications in 5.5%.
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