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García-Fernández MA, Navia J. [Intraoperative transesophageal echocardiography. What for? How? For whom?]. Rev Esp Cardiol 2000; 53:1325-8. [PMID: 11060250 DOI: 10.1016/s0300-8932(00)75236-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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A111 THE CLINICAL IMPLICATION OF A BI-PLANE OR MULTI-PLANE TRANSESOPHAGEAL ECHOCARDIOGRAM ON RECONSTRUCTION SURGERY OF THE RIGHT VENTRICULAR OUTFLOW TRACT. Anesthesiology 1997. [DOI: 10.1097/00000542-199709001-00111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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3
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Sharma S, Stamper T, Dhar P, Emge F, Bailey J, Kanter K, Williams W, Fyfe D. The Usefulness of Transesophageal Echocardiography in the Surgical Management of Older Children with Subaortic Stenosis. Echocardiography 1996; 13:653-662. [PMID: 11442985 DOI: 10.1111/j.1540-8175.1996.tb00951.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Subaortic stenosis is a complex lesion that often presents in older children and adolescents. A clear depiction of the lesion is required for optimization of surgery. Due to the large size of these patients, is not always possible from surface echocardiography. Intraoperative multiplane echocardiography (MTEE) has been performed at our institute in older children for several different congenital heart lesions including many patients with subaortic stenosis. A retrospective analysis of our experience with MTEE in patients with subaortic stenosis was performed to assess its usefulness in the preoperative diagnosis and postoperative assessment of repair. Our results show that intraoperative MTEE was useful preoperatively by correcting or confirming suspected diagnosis, and giving additional details of the lesion in many patients. Postoperatively, MTEE was highly useful in the assessment of repair. We strongly recommend the use of intraoperative MTEE in older children and adolescents with subaortic stenosis. (ECHOCARDIOGRAPHY, Volume 13, November 1996)
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Affiliation(s)
- Shiva Sharma
- The Children's Heart Center, 2040 Ridgewood Dr., NE, Atlanta, GA 30322
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Xu J, Shiota T, Ge S, Gong Z, Rice MJ, Cobanoglu A, Sahn DJ. Intraoperative transesophageal echocardiography using high-resolution biplane 7.5 MHz probes with continuous-wave Doppler capability in infants and children with tetralogy of Fallot. Am J Cardiol 1996; 77:539-42. [PMID: 8629602 DOI: 10.1016/s0002-9149(97)89355-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study reports the role of biplane transesophageal echocardiography in monitoring surgical repairs of tetralogy of Fallot. In our patients, 3 repairs were revised based on transesophageal echocardiography and continuous-wave Doppler results, and intraoperative management was altered in 2 others.
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Affiliation(s)
- J Xu
- The Clinical Care Center for Congenital Heart Disease, Oregon Health Sciences University, Portland, 97201-3098, USA
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Abstract
Advances in echocardiography have enhanced our diagnostic imaging capabilities for congenital heart defects. In addition to improved resolution of two-dimensional images, cardiac hemodynamic assessment is possible with the use of Doppler, color Doppler, and stress echocardiography. Transesophageal echocardiography has allowed intraoperative assessment of cardiac repairs, and fetal echocardiography has allowed development of the field of fetal cardiology. The developing areas of intravascular ultrasonography and three-dimensional echocardiography show promise for the future. Echocardiography continues to revolutionize our ability to diagnose congenital heart defects accurately.
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Affiliation(s)
- M J Rice
- Clinical Care Center for Congenital Heart Disease, School of Medicine, Oregon Health Sciences University, Portland 97201, USA
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Kececioglu D, Olivier M, Vogt J, Scheld HH. Reproducibility of quantitative pediatric transesophageal echocardiography. J Am Soc Echocardiogr 1995; 8:735-8. [PMID: 9417218 DOI: 10.1016/s0894-7317(05)80389-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Transesophageal echocardiography (TEE) is commonly used to monitor cardiac function and to assess cavitary size. For the interpretation of quantitative echocardiographic data, the degree of their reproducibility should be considered. The variability of quantitative TEE was evaluated in this study. To assess intraobserver, beat-to-beat, interobserver, and repositioning variability, TEE examinations of 46 patients with congenital heart defects were analyzed. The mean beat-to-beat variability of 8.5% (range 4.2% to 12.3%) exceeded the mean intraobserver variability of 4.9% (1.9% to 8.1%). The mean interobserver difference between two observers was 3.4% (0.2% to 11.9%). Differences in image acquisition caused by repositioning of the transesophageal probe contributed the most (6.4% to 13.3%; mean 10.5%) to the variability of two-dimensional TEE. Changes seen on TEE studies should be interpreted as abnormal only when they exceed the total variability of this method.
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Affiliation(s)
- D Kececioglu
- Department of Pediatric Cardiology, Westfälische Wilhelms-University, Münster, Germany
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Marx GR. Doppler color flow echocardiography: indispensable application to congenital heart disease. Echocardiography 1995; 12:413-24. [PMID: 10150783 DOI: 10.1111/j.1540-8175.1995.tb00567.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Doppler color flow imaging has become indispensable in the diagnosis and management of patients with congenital heart disease. Certain defects may not be possible, or may be very difficult to diagnose by two-dimensional echocardiography alone. Such examples include multiple ventricular septal defects, anomalous pulmonary venous connection, coronary artery malformations, and the hypertensive patent ductus arteriosus. Additionally, color flow Doppler echocardiography significantly provides additional information, and reduces the time for fetal and transesophageal echocardiographic studies. Doppler color flow imaging has become an essential part of the echocardiographic examination. Experience has broadened the use of this important technological advance, with anticipation of an ever expanding future for its clinical application.
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Affiliation(s)
- G R Marx
- Tufts University School of Medicine, New England Medical College, Boston, Massachusetts, USA
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Gentles TL, Rosenfeld HM, Sanders SP, Laussen PC, Burke RP, van der Velde ME. Pediatric biplane transesophageal echocardiography: preliminary experience. Am Heart J 1994; 128:1225-33. [PMID: 7985605 DOI: 10.1016/0002-8703(94)90755-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Recent development of prototype pediatric biplane transducers has extended the use of biplane TEE imaging to the neonate. One such TEE probe with 64 imaging elements in each pallet was used perioperatively in 46 infants and children (weight 2.9 to 32 kg) undergoing surgery for complex congenital heart disease. The success rate for passing the transducer, complications of the procedure, and the number of cases in which the vertical plane provided information that was not available from the horizontal plane were determined. Probe insertion was successful in all patients. Imaging was discontinued in one neonate because of possible airway compression by the probe. Image quality was excellent in the other 45 patients. The vertical plane added information over that obtained from the horizontal plane in 58 (44%) of the 132 anomalies identified. The addition of the vertical plane was especially useful in imaging abnormalities of the ventricular outflow tracts.
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MESH Headings
- Adolescent
- Anastomosis, Surgical
- Aorta, Thoracic/surgery
- Child
- Child, Preschool
- Echocardiography, Transesophageal/instrumentation
- Echocardiography, Transesophageal/methods
- Fontan Procedure
- Heart Defects, Congenital/diagnostic imaging
- Heart Defects, Congenital/surgery
- Heart Septal Defects, Atrial/diagnostic imaging
- Heart Septal Defects, Ventricular/diagnostic imaging
- Humans
- Infant
- Infant, Newborn
- Monitoring, Intraoperative
- Reoperation
- Transducers
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Affiliation(s)
- T L Gentles
- Department of Cardiology, Children's Hospital, Boston, MA 02115
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Abstract
Monitoring of paediatric anaesthesia has become increasingly more complex in recent years and this is particularly true of cardiac anaesthesia. The purpose of this review is to give a comprehensive update of published material related to both routine and specialized cardiac monitoring. Routine monitoring can be particularly affected by the alterations of cardiac rhythm, blood flow, cardiac output and oxygenation which result from the congenital heart abnormalities themselves, the type of surgery undertaken and the effects of cardiopulmonary bypass. The use of specialized monitoring is becoming more widespread, particularly in the areas of cerebral function, mixed venous oxygenation, cardiac output measurement and coagulation. In the last five years, with the development of smaller probes, a great deal has been published on transoesophageal echocardiography. The use of the current monitors of cerebral function still remains controversial despite the need for a monitor of adequate brain perfusion, reflecting the need for a great deal of further research in this area. This review will concentrate on particular areas which have seen the most profound changes and on monitoring that may form the standards of tomorrow. Finally, amongst all the technology, it should not be forgotten that the most important clinical monitor is the bedside clinical monitoring of the physicians themselves.
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Affiliation(s)
- J P Purday
- Department of Anaesthesia, University of British Columbia, British Columbia's Children's Hospital, Vancouver, Canada
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Benheim A, Karr SS, Sell JE, Midgley FM, Holley D, Martin GR. Routine use of transesophageal echocardiography and color flow imaging in the evaluation and treatment of children with congenital heart disease. Echocardiography 1993; 10:583-93. [PMID: 10146450 DOI: 10.1111/j.1540-8175.1993.tb00074.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We reviewed our experience with transesophageal echocardiography (TEE) and color flow imaging in 157 consecutive patients with known or suspected heart disease to ascertain the impact of this technology on patient care. TEE was performed for diagnostic purposes (22/157), during interventional cardiac catheterizations (13/157), and during operative procedures (122/157). Diagnostic studies were performed after transthoracic echocardiography (TTE) in 21 of 22 patients. TEE was performed because TTE was inconclusive (15/21) or failed to provide sufficient detail of an abnormality (6/21). TEE detected an abnormality in 6 of 15 inconclusive TTEs. TEE was helpful during interventional cardiac catheterizations, particularly during umbrella closure of septal defects and in patients with complex venous and atrial anatomy undergoing transseptal puncture. TEE studies performed before cardiac operations significantly changed the diagnosis in only 5 of 122 (4%) patients, but the information changed the surgical approach in 4 of 5 of these patients. Postoperative TEE assessment more frequently changed care and resulted in further surgical management in 9 of 122 (7%) or a change in medical management in 6 of 122 (5%) patients. TEE was discontinued because of complications before studies were completed in only 4 of 157 (3%) patients. TEE and color flow imaging is a useful adjunct to care of children with known or suspected congenital heart disease.
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Affiliation(s)
- A Benheim
- Department of Pediatrics, George Washington University Medical Center, Washington, DC
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Fontana GP, Ungerleider RM. The surgeon's use of epicardial echocardiography during repair of congenital heart defects. Echocardiography 1992; 9:643-7. [PMID: 10147802 DOI: 10.1111/j.1540-8175.1992.tb00510.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Intraoperative echocardiography in the evaluation of congenital heart defects is a useful method to evaluate surgical anatomy, adequacy of repair, and ventricular performance. Since 1987, 733 patients have undergone epicardial echocardiography during repair. The routine use of this technique has led to the reduction in the need for both early and late reoperation.
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Affiliation(s)
- G P Fontana
- Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710
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Ungerleider RM, Greeley WJ, Kanter RJ, Kisslo JA. The learning curve for intraoperative echocardiography during congenital heart surgery. Ann Thorac Surg 1992; 54:691-6; discussion 696-8. [PMID: 1417226 DOI: 10.1016/0003-4975(92)91013-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Our group has previously reported a large prospective experience with the use of intraoperative echocardiography with Doppler color-flow imaging (IE-DCFI) during the repair of congenital heart defects. We have now performed IE-DCFI in 621 patients and have observed a major change in the impact of this technology, which has stabilized during our most recent experience (the last 207 patients). To evaluate the surgical learning curve with IE-DCFI, we divided patients into three groups: group 1, patients 1 through 207; group 2, patients 208 through 414; and group 3, patients 415 through 621. There were no major differences between groups with respect to age or disease entities. The average time needed to perform an IE-DCFI examination decreased from 3.75 +/- 1.77 minutes in group 1 to 3.35 +/- 1.52 minutes in group 2 and has remained stable. The number of patients requiring revisions in the operating room (based on IE-DCFI findings) decreased from 17 (8%) in group 1 to 7 (3%) in group 2 to 5 (2%) in group 3. Furthermore, revisions were 100% successful in correcting the problem in groups 2 and 3, whereas 18% of group 1 patients left the operating room with persistent residual defects by IE-DCFI. Surgeons can acquire the ability to interpret the results of IE-DCFI themselves and use it to enhance their operative repair of congenital heart defects, but this requires an experience of at least 200 cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R M Ungerleider
- Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710
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Abstract
Transesophageal echocardiography using Doppler color flow mapping with both single plane transverse and longitudinal pediatric probes was performed in 127 infants and children both intraoperatively and postoperatively. The 127 patients ranged in age from 1 day to 18 years (mean 37 months) and in weight from 2.4 to 45 kg (mean 13.2); 157 studies were successfully performed (100% of attempted) with no complications. Transesophageal two-dimensional echocardiography combined with pulsed wave Doppler ultrasound and color flow mapping provided detailed morphologic as well as physiologic information, with additional information provided overall in 56% of the cases. Typical limitations of single-plane transverse imaging were overcome using a prototype longitudinal-axis pediatric probe. Both left and right ventricular outflow tracts, distal pulmonary arteries and all of the interventricular and atrial septa were visualized. Assessment of surgical repair intraoperatively as well as assessment postoperatively for cardiac function, residual intracardiac shunts, residual valvular sequelae and other hemodynamic events was important and easily performed in an otherwise inaccessible patient. Transesophageal echocardiography in infants and in small children is a valuable "noninvasive" imaging technique that offers important additional and complementary information.
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Affiliation(s)
- S B Ritter
- Department of Pediatrics, Mount Sinai School of Medicine, New York, New York 10029
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