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Published on: February 8, 2022
Predictive value of intraoperative transesophageal echocardiography in complete atrioventricular septal defect
Hyun Koo Kim1, Woong-Han Kim, Sung Wook Hwang
1Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon, Korea.
Insights
Intraoperative transesophageal echocardiography (TEE) shows some discrepancies with follow-up transthoracic echocardiography (TTE) in complete atrioventricular septal defects. However, TEE can still predict surgical durability and reduce reoperation rates.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Echocardiography
Background:
- Transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) assess cardiac function in complete atrioventricular septal defects (CAVSD).
- Concerns exist regarding discrepancies between intraoperative TEE and postoperative TTE findings in CAVSD.
- The predictive value of intraoperative TEE for long-term surgical outcomes in CAVSD is debated.
Purpose of the Study:
- To investigate discrepancies between intraoperative TEE and follow-up TTE in patients with CAVSD.
- To evaluate the reliability of intraoperative TEE in predicting long-term surgical results after biventricular repair for CAVSD.
Main Methods:
- Retrospective analysis of 35 patients undergoing biventricular repair for CAVSD.
- Comparison of intraoperative TEE findings with follow-up TTE results obtained at a median of 15.1 months post-surgery.
Main Results:
- Discrepancies between intraoperative TEE and follow-up TTE were observed in 34.3% of left-sided atrioventricular valve regurgitation cases.
- Progression of regurgitation was noted in 28.6% of left-sided and 9.6% of right-sided atrioventricular valves.
- Significant discrepancies requiring reoperation were not identified in the early to midterm follow-up period.
Conclusions:
- Intraoperative TEE findings may differ from follow-up TTE in CAVSD patients.
- The observed discrepancies did not necessitate early reoperation.
- Intraoperative TEE can serve as a valuable tool for predicting the durability of surgical repair and potentially reducing reoperation rates in CAVSD.
Background:
Intraoperative transesophageal echocardiography and follow-up transthoracic echocardiography have been useful in assessing cardiac function in complete atrioventricular septal defects. However, it has been suggested that a discrepancy exists between intraoperative and postoperative findings, and that intraoperative findings cannot reliably predict long-term results. This study aims to determine whether this discrepancy exists and to assess whether it is possible to predict follow-up results using intraoperative transesophageal echocardiography.
Methods:
A retrospective analysis was made in 35 patients who underwent biventricular repair by one surgeon between November 1997 and January 2004. All patients received intraoperative transesophageal echocardiography and follow-up transthoracic echocardiography at 19.1 +/- 18.02 months (range, 7 days to 5 years; median, 15.1 months).
Results:
In left-sided atrioventricular valve regurgitation, 34.3% (12 of 35) of patients showed discrepancy during follow-up, and 28.6% (10 of 35) showed progression of regurgitation (from grade I to II). In right-sided atrioventricular valve, 11.4% (4 of 35) of patients showed discrepancy, 9.6% (3 of 35) showed progression of regurgitation (from grade I to II).
Conclusions:
In complete atrioventricular septal defects, intraoperative transesophageal echocardiography did not show the same findings as that of follow-up transthoracic echocardiography in some cases. However, this discrepancy is not so great as to require reoperation in early to midterm follow-up. Therefore, intraoperative transesophageal echocardiography may be used as tool to predict durability of surgical results and to decrease the incidence of reoperation in complete atrioventricular septal defects.
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