Intraoperative echocardiography as a routine adjunct in assessing repair of congenital heart defects: experience with...

Utility of intraoperative echocardiography (IOE) in perioperative management of congenital heart disease has been reported in literature. However, its consistent use as a monitoring tool has not yet been reported from our country. The aim of this study was to evaluate the role of routine use of IOE for intraoperative assessment of surgical repairs in terms of residual shunt, residual gradient, valvular insufficiency and ventricular function. Three hundred consecutive patients above 3 Kg body weight were included in this study. In 152 patients epicardial and in 148 patients transoesophageal echocardiography (TEE) was performed intraoperatively. Age ranged from 4 months to 52 years (median 5.8 yrs) and body weight from 3 Kg to 62 Kg (Median 12 Kg). IOE Doppler and Doppler colour flow imaging studies were performed before cardiopulmonary bypass (CPB) whenever feasible and after CPB in all patients. Pre-bypass examination yielded additional information in 17 (5.6%) patients. In 9 (3%) such patients it had an impact on surgery. In post CPB IOE studies, surgery was found to be 'perfect' in 210 (70%) patients and 'acceptable' residual defects in 70 (23.3%) patients. In 20 (6.6%) cases post CPB IOE found surgical repair 'unacceptable'. Ten of these patients required immediate surgical revision with excellent outcome, thus saving them from late reoperation or postoperative complications. No short term complications were encountered relating to the procedure. We conclude that intraoperative echocardiography is an inexpensive, accurate, valuable and safe addition to the perioperative care of patients and should be mandatory during all corrective surgical procedures for congenital heart disease. It is especially applicable in our country where the costs of reoperation for residual defects are prohibitive.