An investigation into the causes of unexpected intra-operative transoesophageal echocardiography findings

Area of Science:

• Cardiology
• Medical Imaging
• Surgical Outcomes

Background:

• Pre-operative echocardiography is crucial for cardiac surgery planning.
• Uncertainty exists regarding the accuracy and impact of pre-operative echocardiography findings.
• Potential errors in timing, disease progression assessment, and reporting can affect surgical strategy.

Purpose of the Study:

• To investigate the causes of unexpected intra-operative transoesophageal echocardiography findings.
• To determine the frequency and impact of reporting errors in pre-operative echocardiograms.
• To identify factors contributing to discrepancies between pre-operative and intra-operative echocardiographic assessments.

Main Methods:

• A 33-month audit of unexpected intra-operative transoesophageal echocardiography findings was conducted.
• Pre-operative echocardiography studies and reports were reviewed.
• Causes for unexpected findings were categorized, including reporting errors, imaging limitations, disease progression, and inter-observer variability.

Main Results:

• 6% of patients (50/797) had unexpected intra-operative echocardiography findings, altering surgical strategy in 4% (34/797).
• Reporting errors accounted for 44% (20/46) of unexpected findings, leading to surgical management changes in 90% of affected patients.
• Limitations of transthoracic echocardiography (30%) and disease progression (22%) were other significant causes.

Conclusions:

• Pre-operative echocardiography reporting errors are frequent and clinically significant in cardiac surgery.
• Improved accuracy in echocardiogram reporting is essential to optimize surgical planning and patient outcomes.
• The study underscores the importance of rigorous quality control in echocardiography reporting.