Transesophageal transgastric echocardiography in infants and children: the subcostal view equivalent

Transesophageal echocardiography has been limited in the assessment of congenital heart disease involving ventriculoarterial connections. These can be viewed with biplane imaging, but the angle of incidence does not permit assessment of gradients. To determine whether transgastric transesophageal imaging could provide this information, we examined 127 infants and children during cardiac surgery, ranging from 2.7 to 32 kg in weight and 1 day to 16 years in age. The additional information (if any) provided by the transgastric plane, the frequency with which views could be obtained, the value in examining different congenital heart lesions, and assessing reductions in pressure across the left and right ventricular outflow tracts were determined. Slices obtained from anatomic specimens substantiated the imaging planes and confirmed the anatomic features. Transgastric images were obtained successfully in 89% of patients. Doppler estimates of pressure drops across the ventricular outflow tracts were within good limits of agreement with estimates obtained by manometry. There were no major complications from this technique. We conclude that the transgastric viewing plane enhances the usefulness of intraoperative transesophageal echocardiography for diagnosis and evaluation of congenital heart lesions by permitting more complete echocardiographic examinations and detection of areas of residual obstruction across the ventricular outflow tracts.