Role of intraoperative transesophageal echocardiography during repair of congenital cardiac defects

Intraoperative epicardial echocardiography has been available for several years, and has been demonstrated to be very useful in intraoperative echocardiography. With the availability of small pediatric transesophageal (TEE) probes, it has become possible to perform intraoperative TEE in infants and children of all sizes. With advantages of serial assessment of anatomy, function and flow, and lack of interference in the operative field, TEE has become routine in many surgical centers. Our experience supports its routine use in nearly all patients undergoing repair of congenital heart disease. We generally use pediatric probes in patients less than 15 kg and adult size probes for those over 15 kg. Examinations are performed before and after bypass for use in surgical planning, anesthetic and hemodynamic management, and in evaluation of repairs. In 44 of 667 (6.6%) cases, TEE findings prompted a return to bypass for further surgery or revision of surgery. In 75% of these patients, the problem identified by TEE was relieved, and patients had a good outcome. The benefit obtained by avoiding later reoperation in these patients has also proved cost-effective, supporting the use of TEE on a routine basis. Complications have been few (24/667, 3.5%), without long-term sequelae. They include failure to insert the TEE probe (1.2%), airway obstruction (0.9%), vascular compression (0.7%), tracheal extubation (0.6%) and gastric incision (0.1%); several of these complications are now considered avoidable. Intraoperative TEE offers major advantages in intraoperative assessment and management of patients undergoing repair of congenital heart disease.