Intraoperative transesophageal echocardiography during surgery for congenital heart defects

Guy R. Randolph, Donald J. Hagler, Heidi M. Connolly, Joseph A. Dearani, Francisco J. Puga, Gordon K. Danielson, Martin D. Abel, V. Shane Pankratz, Patrick W. O'Leary

Research output: Contribution to journalArticle

95 Citations (Scopus)

Abstract

Objective: This study was undertaken to further define the impact of intraoperative transesophageal echocardiography during surgery for congenital heart disease and to determine appropriate indications. Methods: The impact of transesophageal echocardiography on patient care was assessed in 1002 patients who underwent this procedure during surgery for congenital heart defects. It had major impact when new information altered the planned procedure or led to a revision of the initial repair. The safety of intraoperative transesophageal echocardiography was evaluated by review of the prospective data sheets and the medical record. A simple relative cost analysis was also performed. Results: Patient median age was 9.9 years (range 2 days to 85 years). Transesophageal echocardiography had prebypass or postbypass major impact in 13.8% of cases (n = 138/1002). Major impact was more frequent during reoperations (P < .03). Procedures that benefited most from the additional information were valve repairs (aortic or atrioventricular) and complex outflow tract reconstructions. Partial anomalous pulmonary venous connection, tricuspid valve repair (other than of Ebstein anomaly), simple atrioventricular discordance, aortic arch anomalies, and secundum atrial septal defects had major impact rates less than 5%. No major complications occurred. Minor complications occurred in 1% of patients and were most often observed in infants smaller than 4 kg. Routine use of transesophageal echocardiography for all patients with congenital heart defects proved cost-effective. Conclusions: On the combined basis of the observed rates of major impact, the minimal complications, and the relative cost advantage, we believe that routine use of transesophageal echocardiography during most intracardiac repairs of congenital heart defects is justified, particularly for patients undergoing repeat operations for congenital cardiac malformations.

Original languageEnglish (US)
Pages (from-to)1176-1182
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume124
Issue number6
DOIs
StatePublished - Dec 1 2002

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Congenital Heart Defects
Transesophageal Echocardiography
Costs and Cost Analysis
Ebstein Anomaly
Tricuspid Valve
Atrial Heart Septal Defects
Thoracic Aorta
Aortic Valve
Reoperation
Medical Records
Heart Diseases
Patient Care
Safety
Lung

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Randolph, G. R., Hagler, D. J., Connolly, H. M., Dearani, J. A., Puga, F. J., Danielson, G. K., ... O'Leary, P. W. (2002). Intraoperative transesophageal echocardiography during surgery for congenital heart defects. Journal of Thoracic and Cardiovascular Surgery, 124(6), 1176-1182. https://doi.org/10.1067/mtc.2002.125816

Intraoperative transesophageal echocardiography during surgery for congenital heart defects. / Randolph, Guy R.; Hagler, Donald J.; Connolly, Heidi M.; Dearani, Joseph A.; Puga, Francisco J.; Danielson, Gordon K.; Abel, Martin D.; Shane Pankratz, V.; O'Leary, Patrick W.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 124, No. 6, 01.12.2002, p. 1176-1182.

Research output: Contribution to journalArticle

Randolph, GR, Hagler, DJ, Connolly, HM, Dearani, JA, Puga, FJ, Danielson, GK, Abel, MD, Shane Pankratz, V & O'Leary, PW 2002, 'Intraoperative transesophageal echocardiography during surgery for congenital heart defects', Journal of Thoracic and Cardiovascular Surgery, vol. 124, no. 6, pp. 1176-1182. https://doi.org/10.1067/mtc.2002.125816
Randolph, Guy R. ; Hagler, Donald J. ; Connolly, Heidi M. ; Dearani, Joseph A. ; Puga, Francisco J. ; Danielson, Gordon K. ; Abel, Martin D. ; Shane Pankratz, V. ; O'Leary, Patrick W. / Intraoperative transesophageal echocardiography during surgery for congenital heart defects. In: Journal of Thoracic and Cardiovascular Surgery. 2002 ; Vol. 124, No. 6. pp. 1176-1182.
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AU - Danielson, Gordon K.

AU - Abel, Martin D.

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