The impact of additional epicardial imaging to transesophageal echocardiography on intraoperative detection of residual lesions in congenital heart surgery

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Presentation transcript:

The impact of additional epicardial imaging to transesophageal echocardiography on intraoperative detection of residual lesions in congenital heart surgery Andreea Dragulescu, MD, PhD, Fraser Golding, MD, Glen Van Arsdell, MD, Christopher Caldarone, MD, Luc Mertens, MD, PhD, Osman Al-Radi, MD, Kyong-Jin Lee, MD The Journal of Thoracic and Cardiovascular Surgery Volume 143, Issue 2, Pages 361-367.e1 (February 2012) DOI: 10.1016/j.jtcvs.2011.06.010 Copyright © 2012 Terms and Conditions

Figure 1 Intraoperative echocardiography in a 5-month-old child after repair of Fallot-type double outlet right ventricle. Postoperative TEE showed a good intracardiac result but turbulence at the origin of the pulmonary arteries (A, B). Further epicardial imaging confirmed narrowing at the origin of the right pulmonary artery (C) and small left pulmonary artery (D) with significant gradients. Diagnostic catheterization (E, F) showed suprasystemic right ventricular pressures, stenosis at the origin of right pulmonary artery (peak gradient 33 mm Hg), and diffusely hypoplastic left pulmonary artery. The patient underwent surgical revision for patch enlargement of branch pulmonary arteries with a good result. Ao, Aorta; LPA, left pulmonary artery; MPA, main pulmonary artery; RPA, right pulmonary artery. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 361-367.e1DOI: (10.1016/j.jtcvs.2011.06.010) Copyright © 2012 Terms and Conditions

Figure 2 Neonate with transposition of the great arteries, ventricular septal defect, and usual coronary anatomy. As the patient was removed from bypass, TEE showed reduced ventricular function and laminar flow in the right coronary artery (C), but the left coronary artery could not be properly imaged. After surgical revision, EpE showed turbulent flow in the left coronary artery (A, B), which improved with further revision. At chest closure (day 5), there was severe ventricular dysfunction and electrocardiogram changes consistent with ischemia. Angiography (D) showed stenosis of left coronary artery leading to surgical revision. As the patient was removed from bypass, EpE showed laminar flow in the left coronary artery (E, F). Ao, Aorta; LA, left atrium; LCA, left coronary artery; PA, pulmonary artery; RCA, right pulmonary artery. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 361-367.e1DOI: (10.1016/j.jtcvs.2011.06.010) Copyright © 2012 Terms and Conditions

Figure 3 Use of EpE during the study period: 22 cases (6%) in 2007; 25 cases (6.3%) in 2008; 48 cases (10.9%) in 2009 (P < .01). There was a significant increase in the use of EpE to obtain additional information. PA, Pulmonary artery. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 361-367.e1DOI: (10.1016/j.jtcvs.2011.06.010) Copyright © 2012 Terms and Conditions