Predictive Value of Intraoperative Diagnosis of Residual Ventricular Septal Defects by Transesophageal Echocardiography Baher M. Hanna, Ahmed A. El-Hewala,

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Predictive Value of Intraoperative Diagnosis of Residual Ventricular Septal Defects by Transesophageal Echocardiography Baher M. Hanna, Ahmed A. El-Hewala, Peter J. Gruber, MD, PhD, J. William Gaynor, MD, Thomas L. Spray, MD, Mohamed A. Seliem, MD, FACC The Annals of Thoracic Surgery Volume 89, Issue 4, Pages 1233-1237 (April 2010) DOI: 10.1016/j.athoracsur.2009.10.058 Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 A flow chart showing a longitudinal follow-up of 690 patients (Pts) with different types of ventricular septal defect (VSD) at three definite times; at the intraoperative transesophageal echocardiography (IOTEE), at a predischarge transthoracic echocardiographic examination (TTE), and at a remote transthoracic echocardiographic examination. (Echo = echocardiography; TEE = transesophageal echocardiography.) The Annals of Thoracic Surgery 2010 89, 1233-1237DOI: (10.1016/j.athoracsur.2009.10.058) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) A pie chart showing the total number of patients who underwent repair of ventricular septal defect (VSD), number of those without residual ventricular septal defect, those with residual shunt on the intraoperative transesophageal echocardiography (IOTEE), and those requiring repeat cardiopulmonary bypass. (B) A pie chart showing the total number of patients who had a predischarge transthoracic echocardiographic examination (TTE), those who had a negative or positive intraoperative transesophageal echocardiography, those with a ventricular septal defect that was not detected by intraoperative transesophageal echocardiography but was seen on the predischarge transthoracic echocardiographic examination, and those requiring reoperation during the same hospitalization. (C) A pie chart showing the late transthoracic echocardiographic examination with a much smaller number of patients with residual ventricular septal defect. The Annals of Thoracic Surgery 2010 89, 1233-1237DOI: (10.1016/j.athoracsur.2009.10.058) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Transthoracic echocardiographic image with color comparison showing an example of a residual intramural ventricular septal defect (long arrow) after repair of double-outlet right ventricle. The ventricular septal defect patch (small arrow) seems intact, and the residual defect is through the trabeculations around the distal edge of the patch, with left to right shunt into the right ventricular outflow tract (star). The number of ventricular septal defects was 37. The Annals of Thoracic Surgery 2010 89, 1233-1237DOI: (10.1016/j.athoracsur.2009.10.058) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions