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J Thorac Cardiovasc Surg 2002;124:1176-1182
© 2002 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease (CHD)

Intraoperative transesophageal echocardiography during surgery for congenital heart defects

From the Division of Pediatric Cardiology,^a the Division of Cardiovascular Diseases and Internal Medicine,^b the Division of Cardiovascular Surgery,^c the Department of Anesthesiology,^d and the Section of Biostatistics,^e Mayo Clinic, Rochester, Minn.

Supported in part by an internal grant from the Mayo Foundation.

Received for publication Sept 9, 2001. Revisions requested Sept 11, 2001; revisions received April 11, 2002. Accepted for publication April 18, 2002. Address for reprints: Patrick W. O'Leary, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (E-mail: poleary{at}mayo.edu).

Objective: This study was undertaken to further define the impact of intraoperative transesophageal echocardiography during surgery for congenital heart disease and to determine appropriate indications.
Methods: The impact of transesophageal echocardiography on patient care was assessed in 1002 patients who underwent this procedure during surgery for congenital heart defects. It had major impact when new information altered the planned procedure or led to a revision of the initial repair. The safety of intraoperative transesophageal echocardiography was evaluated by review of the prospective data sheets and the medical record. A simple relative cost analysis was also performed.
Results: Patient median age was 9.9 years (range 2 days to 85 years). Transesophageal echocardiography had prebypass or postbypass major impact in 13.8% of cases (n = 138/1002). Major impact was more frequent during reoperations (P < .03). Procedures that benefited most from the additional information were valve repairs (aortic or atrioventricular) and complex outflow tract reconstructions. Partial anomalous pulmonary venous connection, tricuspid valve repair (other than of Ebstein anomaly), simple atrioventricular discordance, aortic arch anomalies, and secundum atrial septal defects had major impact rates less than 5%. No major complications occurred. Minor complications occurred in 1% of patients and were most often observed in infants smaller than 4 kg. Routine use of transesophageal echocardiography for all patients with congenital heart defects proved cost-effective.
Conclusions: On the combined basis of the observed rates of major impact, the minimal complications, and the relative cost advantage, we believe that routine use of transesophageal echocardiography during most intracardiac repairs of congenital heart defects is justified, particularly for patients undergoing repeat operations for congenital cardiac malformations.

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