Abstract
Aim: To test the benefits of intraoperative echocardiography (IOE) in children undergoing surgery for congenital heart defect (CHD). Method: A retrospective study of 2,324 patients operated off-pump for CHD in the Pediatric Heart Center from October 1994 (introduction of IOE) through 2003.
IOE was performed in 350 (15%) at the request of the surgeon. We compared the results of preoperative, intraoperative, and postoperative echocardiography using our pre-defined semiquantitative criteria.
Results: IOE was most often requested by the surgeon in patients with atrioventricular (22.6%) and ventricular septal defects (15.1%), and with tetralogy of Fallot (9.3%). Judging by IOE, excellent operative outcome was obtained in 205 (59 %) patients, satisfactory in 100 (29%), and unsatisfactory in 40 (12%) surgical patients.
In the whole group of 2,324 patients, unacceptable outcome requiring early re-operation was documented in 126 (5.4%) cases. The proportion of un-acceptable outcomes was significantly higher in patients undergoing IOE (11.6%; p < 0.001) compared with those in whom IOE was not requested by the surgeon (4.3%).
Defects with the most frequently unacceptable surgical outcome in the whole group of surgical patients included Ebstein s anomaly of the tricuspid valve (6/15, i. e., 40.0%), mitral valve anomaly (5/26, i. e., 19.2%), aortic insufficiency (3/20, i. e., 15.0 %) and atrioventricular septal defect (18/192, i. e., 9.4%). Conclusion: IOE should be undertaken on a routine basis in all patients whereby the surgeon performs atrioventricular or semilunar valvuloplasty.
By contrast, IOE is indicated very rarely in simple atrial and ventricular septal defects and transposition of the great arteries. In other cases, IOE is recommended whenever the surgeon is unsure about the outcome of the procedure.
Intraoperative detection and elimination of major operative residua will reduce the need for subsequent re-operation and the incidence potential deaths. In addition, it significantly helps cut down costs associated with late re-operation.