Biplane intraoperative transesophageal echocardiography in congenital heart disease

To evaluate the accuracy, value, and safety of biplane intraoperative transesophageal echocardiography (TEE) in patients with congenital cardiac malformations.

We reviewed the results of the first 104 consecutive biplane intraoperative TEE examinations performed during the repair of congenital heart defects at the Mayo Clinic.

TEE results were analyzed for accuracy of diagnosis, effect on the surgical procedure, and associated complications. In a subjective analysis, the relative contributions and advantages of each imaging plane (transverse and longitudinal) were also assessed.

Biplane TEE had "significant impact" on intraoperative management in 17 of 104 examinations (16.3%). Preoperative TEE altered the planned procedure in 11 patients (10.6%). Postbypass biplane TEE led to immediate revision of the initial repair in nine patients (8.7%). Patients who underwent modified Fontan operations or subaortic resections had the greatest frequency of significant impact (40% [P = 0.006] and 33% [P = 0.03], respectively). No major complications were associated with TEE. For a complete examination, use of both imaging planes was necessary in all the patients studied.

Biplane TEE is an accurate, valuable, and safe addition to the perioperative care of patients with congenital heart disease. Although intraoperative TEE is not needed in all operations for congenital heart disease, we recommend that biplane intraoperative TEE be performed routinely during modified Fontan procedures, subaortic resections, and other intracardiac operations for complex congenital cardiac malformations.