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The Journal of Thoracic and Cardiovascular Surgery, Vol 100, 297-309, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Routine use of intraoperative epicardial echocardiography and Doppler color flow imaging to guide and evaluate repair of congenital heart lesions. A prospective study

RM Ungerleider, WJ Greeley, KH Sheikh, J Philips, FB Pearce, FH Kern and JA Kisslo
Department of Surgery, Duke University Medical Center, Durham, N.C. 27710.

Routine epicardial two-dimensional echocardiography, Doppler, and Doppler color flow imaging studies were performed before and after cardiopulmonary bypass in 328 patients undergoing operations for congenital heart disease. Ages ranged from 1 day to 59 years (mean 5.9 years); the smallest patient was 1.8 kg. Complete examinations were conducted in 3.6 +/- 1.7 minutes. Prebypass examinations demonstrated previously unappreciated details of anatomy in 60 patients (18%), which did not relate to whether catheterization had been performed, and they were believed to play a role in surgical planning in 143 patients (44%). Discovery of previously unrecognized features of anatomy increased the impact of echo-Doppler color flow imaging on operative planning by 2.5 times. After bypass, echo-Doppler color flow imaging disclosed unsuspected residual defects in 22 patients (7%) who were doing well clinically and enabled an attempt at immediate revision of the procedure. When ultimate clinical outcome was compared to postbypass findings of echo-Doppler color flow imaging, the presence of a residual defect, right or left ventricular dysfunction, or any concern with the heart by echo-Doppler color flow imaging appeared to serve as a predictor of unfavorable outcome (p less than 0.001 for each when compared with absence of these difficulties). Thus routine intraoperative echo-Doppler color flow imaging is useful in aiding the planning, conduct, and assessment of results in operations for congenital heart disease.

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