Related Experiment Videos
Transesophageal echocardiography in evaluation and management after a Fontan procedure
O Stümper1, G R Sutherland, R Geuskens
1Academic Hospital Rotterdam, Sophia Children's Hospital, The Netherlands.
Insights
Transesophageal echocardiography (TEE) offers superior assessment of Fontan-procedure outcomes compared to precordial ultrasound. TEE aids in diagnosing shunts, obstruction, and valvular regurgitation, proving valuable for monitoring Fontan circulation.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Background:
- The Fontan procedure is a complex surgical palliation for single-ventricle congenital heart disease.
- Accurate postoperative assessment is crucial for managing Fontan circulation and identifying complications.
- Traditional precordial echocardiography has limitations in visualizing intricate intracardiac and extracardiac pathways.
Purpose of the Study:
- To evaluate the diagnostic utility of transesophageal echocardiography (TEE) in assessing immediate and intermediate outcomes after Fontan-type procedures.
- To compare the efficacy of TEE with precordial echocardiography and cardiac catheterization in Fontan patients.
- To determine TEE's role in detecting specific complications such as shunting, obstruction, thrombus formation, and valvular regurgitation.
Main Methods:
- Transesophageal echocardiography was performed in 18 pediatric patients post-Fontan procedure.
- Findings were correlated with concurrent precordial echocardiography and, in a subset, cardiac catheterization data.
- Specific parameters assessed included atrial shunting, pulmonary artery obstruction, Fontan connection integrity, Glenn shunt visualization, thrombus formation, atrioventricular valvular regurgitation, and coronary artery fistulas.
Main Results:
- TEE identified atrial shunting in 3 patients (vs. 1 with precordial echo) and pulmonary artery obstruction in 3 patients (vs. 1).
- Evaluation of anterior Fontan connections was more successful with TEE (5/8) than precordial echo (6/8), while posterior connections were better visualized by TEE (10/10).
- TEE detected thrombus formation in 3 patients and better defined atrioventricular valvular regurgitation (11/18) compared to precordial echo (5/18). Coronary artery fistulas were identified in 2 cases by TEE, missed by precordial echo.
Conclusions:
- Transesophageal echocardiography is a highly effective diagnostic and monitoring tool for patients after Fontan procedures.
- TEE provides superior visualization and characterization of Fontan circulation complications compared to precordial echocardiography.
- TEE offers substantial additional value to cardiac catheterization and is recommended for comprehensive postoperative management.
Abstract:
Transesophageal echocardiography was used in 18 patients (aged 1.6 to 34 years, mean age 12.6) to assess the immediate (5 patients) or intermediate (13 patients) results after a Fontan-type procedure. The findings were correlated with precordial echocardiographic (all patients) and cardiac catheterization (11 patients) data. Atrial shunting was documented by transesophageal studies in three patients (precordial in one patient). In two patients it was confirmed by cardiac catheterization; the third underwent reoperation based on the transesophageal study alone. Pulmonary artery obstruction was documented in three patients (precordial in one patient) and was confirmed by subsequent cardiac catheterization in all. Evaluation of anterior Fontan connections was successful in 5 of 8 patients (precordial in 6 of 8), and posterior connections in 10 of 10 patients (precordial in 5 of 10). A Glenn shunt could be evaluated in eight of nine patients (precordial in three of nine). Thrombus formation was detected by transesophageal studies in three patients (precordial in one patient); repeat studies were used to evaluate thrombolytic therapy in two. Atrioventricular valvular regurgitation (11 of 18 patients) was better defined by transesophageal than by precordial studies (5 of 18). A coronary artery fistula was identified in two cases (precordial in none). Transesophageal pulsed Doppler interrogation of pulmonary artery and pulmonary vein flow patterns consistently allowed a detailed evaluation of the Fontan circulation. Transesophageal echocardiography is an important diagnostic and monitoring technique after the Fontan procedure. In this series, it was far superior to precordial ultrasound evaluation and of substantial additional value to cardiac catheterization.