Accuracy of Intraoperative Epicardial Echocardiography in the Assessment of Surgical Repair of Congenital Heart Defects confirmed

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Abstract

Objective:

To determine the accuracy of epicardial echocardiography in detecting residual lesions after surgical repair of congenital heart defects. To determine the sensitivity, specificity, positive predictive valve, negative predictive valve, and false negative and false positive percentage of the same.

Materials and Methods:

One year hospital-based prospective study of epicardial echocardiography in patients undergoing cardiopulmonary bypass for surgical correction of congenital heart defects in children and adults.

Results:

Epicardial echocardiography was done in 158 patients. Residual lesions were detected in 38 patients by epicardial echocardiography. In 28 of these cases the residual lesions were significant. In 24 of them immediate reoperation was done with good outcome. Epicardial echo has high sensitivity, specificity, positive and negative predictive valve, in detecting residual lesion with congenital heart defects.

Conclusion:

Routine use of intraoperative epicardial echocardiography allows detection of majority of residual defects. It has high accuracy. There were no complications associated with use of epicardial echocardiography. The use of transesophageal echocardiography (TEE) can be avoided in small children and neonates undergoing cardiac surgery.

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Most cited references 16

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Paediatric heart care in India.

Penmetcha Kumar, S Shrivastava (2008)

There have been few systematic efforts to define the burden of paediatric heart disease in India. Estimates based on published studies on congenital heart disease (CHD) at birth suggest a massive CHD burden. Absolute numbers of children with other heart diseases are also likely to be substantial. Given the enormity of the problem the number of paediatric heart programmes and specially trained paediatric cardiologists and paediatric cardiac surgeons are woefully inadequate. They are largely clustered in those parts of India that are experiencing improving economy and human development. For the average family the cost of care of a child with heart disease is prohibitive because care of children with heart disease often requires considerable human and material resources, together with sophisticated technology. While paediatric cardiology is only now being recognised in India as a major specialty, there is a need to intensify efforts to develop the specialty especially in those parts of India where there are very few centres. The present challenges are many and they include obtaining representative data on disease burden, establishing quality institutions with comprehensive paediatric cardiac programme training a cadre of professionals for paediatric heart care, developing cost-effective management strategies and improving awareness on diagnosis and management of paediatric heart diseases.

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Intraoperative echocardiography in infants and children with congenital cardiac shunt lesions: transesophageal versus epicardial echocardiography.

Isobel Muhiudeen, David Roberson, Norman Silverman … (1990)

To determine the utility and limitations of intraoperative transesophageal echocardiography in infants and children with congenital intracardiac shunts, intraoperative transesophageal (n = 50) and epicardial (n = 49) echocardiograms were performed before and after cardiopulmonary bypass in children from 4 days to 16 years old and 3 to 45 kg in body weight. A miniaturized transesophageal probe (6.9 mm maximal diameter) was used in 36 patients weighting less than or equal to 20 kg. Epicardial imaging was performed with a 5 MHz precordial probe. The intraoperative transesophageal echocardiographic findings before and after cardiopulmonary bypass were correct and complete in 94% of patients. Transesophageal echocardiography correctly identified atrial septal defects, most types of ventricular septal defects, anomalous pulmonary veins, atrioventricular septal defects, tetralogy of Fallot, truncus arteriosus and double inlet ventricles. It failed to provide a correct diagnosis in only three patients, all of whom had doubly committed subarterial ventricular septal defects. Epicardial echocardiography identified all cases that had a doubly committed subarterial ventricular septal defect. A correct and complete intraoperative diagnosis was obtained with the use of epicardial imaging in 92% before and after cardiopulmonary bypass, but this technique required interruption of surgery and could not be completed in three patients because of induced arrhythmias and hypotension. These results demonstrated that intraoperative transesophageal echocardiography consistently defined important morphologic, color and pulsed Doppler ultrasound features of most congenital shunt lesions. Lesions that involved the right ventricular outflow tract are sometimes difficult to image with uniplane transesophageal echocardiography. There were no complications in any of the 50 subjects.

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Efficacy of intraoperative transesophageal echocardiography in children with congenital heart disease.

S Cyran, T R Kimball, R Meyer … (1989)

The feasibility and potential adverse effects of using intraoperative transesophageal echocardiography (TEE) in 19 children ages 7.5 to 16 years undergoing surgical repair of a variety of congenital heart defects were evaluated. The ability of TEE to assess the adequacy of surgical repair as well as left ventricular function and wall motion abnormalities in this setting was also examined. Intraoperative transesophageal 2-dimensional and Doppler evaluation, and, in selected patients, echo-contrast and color flow imaging, were performed with either a 3.5- or 5.0-MHz phased array probe mounted within the tip of a flexible gastroscope. Probe insertion was successful in 18 of 19 patients. Fiberoptic endoscopy (9 patients) and autopsy (1 patient--cardiac donor) performed within 24 hours of surgery demonstrated no significant esophageal abnormalities. Intraoperative wall motion abnormalities were identified in 8 patients but did not persist after the operation. An adequate surgical repair was demonstrated by contrast and color flow imaging in most patients. Microcavitation was detected in 6 patients for greater than 5 minutes after a standard debubbling procedure. No patient displayed any adverse neurologic effects. It is concluded that, with the currently available probes, intraoperative TEE can be performed safely and reliably in children as young as 7.5 years of age. The procedure provides valuable information regarding wall motion abnormalities, cardiac function and the adequacy of surgical repair.

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Author and article information

Journal

Journal ID (nlm-ta): J Cardiovasc Ecogr

Journal ID (iso-abbrev): J Cardiovasc Ecogr

Journal ID (publisher-id): JCE

Title: Journal of Cardiovascular Echography

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 2211-4122

ISSN (Electronic): 2347-193X

Publication date (Print): Apr-Jun 2013

Volume: 23

Issue: 2

Pages: 60-65

Affiliations

[1] Department of Pediatric Cardiology, Karnatak Lingayat Education Society, Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum, India

[1 ] Director, Karnatak Lingayat Education Society Heart Foundation, Belgaum, Karnataka, India

[2 ] Consultant Pediatric Cardiac Surgeon, Karnatak Lingayat Education Society, Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum, Karnataka, India

[3 ] Department of Cardiac Anesthesia, Jawaharlal Nehru Medical College, Karnatak Lingayat Education Society, Belgaum, Karnataka, India

[4 ] Consultant Pediatric Cardiac Intensivist, Karnatak Lingayat Education Society Heart Foundation, Belgaum, Karnataka, India

Author notes

Address for correspondence Dr. Veeresh F. Manvi, Senior Consultant Pediatric Cardiology, Karnatak Lingayat Education Society, Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum - 590 010, Karnataka, India. E-mail: veereshmanvi@ 123456yahoo.co.in

Article

Publisher ID: JCE-23-60

DOI: 10.4103/2211-4122.123032

PMC ID: 5353393

PubMed ID: 28465885

SO-VID: cd1fbc99-e7bc-4f49-aa5e-e4145feccb36

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This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Accuracy of Intraoperative Epicardial Echocardiography in the Assessment of Surgical Repair of Congenital Heart Defects confirmed

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Abstract

Objective:

Materials and Methods:

Results:

Conclusion:

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Most cited references 16

Paediatric heart care in India.

Intraoperative echocardiography in infants and children with congenital cardiac shunt lesions: transesophageal versus epicardial echocardiography.

Efficacy of intraoperative transesophageal echocardiography in children with congenital heart disease.

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