Original Articles
Transesophageal echocardiography for cardiac surgery in children*

Presented in summary form at the 91st Meeting of the Japan Society of Anesthesiology, Hamamatsu, February 3, 2001.
https://doi.org/10.1053/jcan.2002.126953Get rights and content

Abstract

Objective: To evaluate the usefulness of transesophageal echocardiography (TEE) for cardiac surgery in children. Design: Prospective clinical study. Setting: Nagoya City University Hospital. Participants: Children who had cardiac surgery from January 1998 to December 2000 (n = 90). Interventions: TEE was used to the extent permitted by the probe size and the position of the patient during surgery. Measurements and Main Results: TEE monitoring was performed safely without any complications in 88 of the patients. Based on the TEE findings, the anesthesiologists conferred with the surgeon about the efficacy of the surgical procedures in 11 patients (11 of 88 [12.5%]). The cardiac surgeons altered the surgical repair in 2 patients based on the TEE findings (2 of 88 [2.4%]). Conclusion: TEE is a valuable diagnostic tool for monitoring during cardiac surgery in children. The person who performs the TEE should use it carefully after obtaining thorough knowledge of the pathophysiology of pediatric cardiac diseases, their surgical indications, and how specific surgical procedures are done. Copyright 2002, Elsevier Science (USA). All rights reserved.

Section snippets

Methods

Of the approximately 100 cardiovascular operations done at this institution annually, 70% are cardiac operations for complex cardiac anomalies in children (Table 1).

. Pediatric cardiac surgery

Cases that mainly become curative surgery in the neonatal period or early infancy
 CoA complex4
 Simple CoA1
 IAA complex1
 Jatene6
 PAPVC1
 TAPVC1
 VSD PH3
Cases that mainly become curative surgery from 1 year of age onward
 TOF radical4
 Rastelli3
 CAVC1
 VSD4
 ASD2 (1 case + RVOTR)
 Ebstein1
 Valve2
Shunt surgery in stages
 BT shunt15
 

Results

TEE was attempted in 90 of the approximately 200 pediatric cardiac surgery cases during the 3-year period from January 1998 to December 2000; it was possible to use TEE in 88 of them. Bradycardia was associated with insertion of the esophageal probe in 2 of the cases, and the probe was removed. In all 88 patients in whom TEE was useful, it was employed for reevaluating the preoperative diagnosis, checking for residual air in the left heart after declamping the aorta, and evaluating heart

Discussion

The role of TEE in the perioperative period is summarized in Table 3.

. Role of perioperative transesophageal echocardiography

Before cardiopulmonary bypass
 Confirmation of the preoperative diagnosis
 Diagnosis of the cause of circulatory changes (eg, circulatory changes owing to compression of the heart and great vessels, bleeding, changes in systemic and pulmonary vascular resistance)
While on the heart-lung machine
 Ensure myocardial protection (infusion of myocardial protective solution, cardiac

References (7)

There are more references available in the full text version of this article.

Cited by (14)

  • A New Transesophageal Probe for Newborns

    2009, Ultrasound in Medicine and Biology
    Citation Excerpt :

    Until 1990, TEE evaluation in infants and children was not possible because probes were too large (Muhiudeen et al. 1998). The development of miniaturized single- and biplane probes (from 3.3 to 9 mm diameter) generated a number of studies, which demonstrated that TEE can be performed safely in the pediatric population (Bruce et al. 2002; Andropoulus et al. 2000; Yumoto et al. 2002). A multiplane TEE probe is an obvious advantage, certainly considering the complexity of the intracardiac defects in neonates (Shiota et al.1999; Tardif et al. 1994; Yvorchuk et al. 1995).

  • Intraoperative Transesophageal Ventricular Pacing in Pediatric Patients

    2008, Journal of Cardiothoracic and Vascular Anesthesia
    Citation Excerpt :

    Simultaneous transesophageal pacing and TEE monitoring are useful, especially in patients who need intraoperative cardiac pacing. Intraoperative TEE can provide continuous assessment of cardiac function and anatomy.12 However, the size of a TEE probe may limit this application in small pediatric patients because of its complications (eg, tracheal obstruction and hypotension caused by compression of the left atrium).

  • Intraoperative and Postoperative Applications

    2021, Transesophageal Echocardiography for Pediatric and Congenital Heart Disease, Second Edition
  • Atrioventricular Septal Defects

    2021, Transesophageal Echocardiography for Pediatric and Congenital Heart Disease, Second Edition
View all citing articles on Scopus
*

Address reprint requests to Miho Yumoto, MD, Departments of Anesthesiology, Nagoya City University School of Medicine, Kawasumi 1, Mizuho-cho Mizuho, Nagoya, Japan. E-mail: [email protected]

View full text