Related Experiment Video
Updated: Mar 9, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Practice Patterns in Postoperative Echocardiographic Surveillance after Congenital Heart Surgery in Children: A
Alisa Arunamata1, David M Axelrod1, Alaina K Kipps1
1Department of Pediatrics, Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Stanford University Medical Center, Palo Alto, CA.
Insights
Postoperative echocardiograms after congenital heart surgery show wide variation in use. Higher frequency was linked to longer hospital stays and worse outcomes, suggesting a need for evidence-based guidelines.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Medical Imaging
Background:
- Postoperative surveillance imaging is crucial after congenital heart surgery.
- Current practices for inpatient echocardiographic surveillance vary significantly within institutions.
Purpose of the Study:
- To review current institutional practices for postoperative imaging surveillance after congenital heart surgery.
- To identify factors contributing to variations in the use of echocardiograms.
Main Methods:
- Retrospective review of medical records for children undergoing congenital heart surgery between June and December 2014.
- Data collected included number and indications for postoperative transthoracic echocardiograms (TTEs), provider involvement, length of stay, and Risk-Adjustment for Congenital Heart Surgery-1 (RACHS-1) scores.
Main Results:
- 253 children received 556 TTEs; 23% had 3 or more TTEs.
- Only 2.7% of TTEs revealed new abnormal findings.
- Patients with 3+ TTEs had higher RACHS-1 scores, longer intensive care unit and hospital stays, and increased need for mechanical circulatory support.
Conclusions:
- Significant intra-institutional variation exists in echocardiographic surveillance post-congenital heart surgery.
- Echocardiogram frequency correlates with surgical complexity and patient's postoperative condition.
- Findings support the development of evidence-based guidelines for postoperative echocardiographic surveillance.
Objectives:
To review current institutional practice and describe factors contributing to variation in inpatient postoperative imaging surveillance after congenital heart surgery.
Study Design:
We reviewed records of all children who underwent congenital heart surgery from June to December 2014. Number and primary indications for postoperative transthoracic echocardiograms (TTEs), providers involved, cardiovascular intensive care unit (CVICU) and total hospital length of stay, and Risk-Adjustment for Congenital Heart Surgery-1 scores were recorded.
Results:
A total of 253 children (age at surgery: 8 months [2 days-19 years]) received 556 postoperative TTEs (median 1 TTE/patient [1-14]), and 23% had ≥3 TTEs. Fifteen of 556 TTEs (2.7%) revealed a new abnormal finding. The majority of TTEs (59%) were performed in the CVICU (1.5 ± 1.1 TTEs/week/patient), with evaluation of function as the most common indication (44%). Attending physician practice >10 years was not associated with fewer TTEs (P = .12). Patients with ≥3 TTEs had higher Risk-Adjustment for Congenital Heart Surgery-1 scores (P = .001), longer CVICU lengths of stay (22 vs 3 days; P < .0001), longer overall hospitalizations (28 vs 7 days; P < .0001), and a higher incidence of mechanical circulatory support (10% vs 0%; P < .0001) than those with <3 TTEs. Eight patients with ≥3 TTEs did not survive, compared with 3 with <3 TTEs (P = .0004).
Conclusions:
There was wide intra-institutional variation in echocardiographic use among similar complexity surgeries. Frequency of postoperative echocardiographic surveillance was associated with degree of surgical complexity and severity of postoperative clinical condition. Few studies revealed new abnormal findings. These results may help establish evidence-based guidelines for inpatient echocardiographic surveillance after congenital heart surgery.
Related Concept Videos
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for...
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:18Endocarditis III: Medical Management
01:30Pulse rhythm
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...
01:22Mitral Valve Prolapse II: Assessment and Management