Related Experiment Videos
Usefulness of transesophageal echocardiography in the pediatric catheterization laboratory
R Tumbarello1, A Sanna, G Cardu
1Servizio di Cardiologia Emodinamica, Ospedale San Michele, Cagliari, Italy.
Insights
Transesophageal echocardiography effectively monitored pediatric cardiac catheterizations, guiding interventions like valve dilation and duct closure. This imaging technique offers precise guidance and complication assessment, potentially improving procedures for children.
Area of Science:
- Pediatric Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Cardiac catheterization is a key diagnostic and therapeutic tool for pediatric heart conditions.
- Transesophageal echocardiography (TEE) offers real-time, high-resolution cardiac imaging.
- Its utility in monitoring pediatric cardiac catheterization requires further evaluation.
Purpose of the Study:
- To assess the feasibility and effectiveness of transesophageal echocardiography (TEE) during pediatric cardiac catheterization.
- To evaluate TEE's role in guiding interventional procedures and diagnosing complications.
- To explore TEE's potential to optimize procedural outcomes in children.
Main Methods:
- TEE was performed in 51 children (aged 2-14 years) undergoing elective cardiac catheterization.
- Procedures included percutaneous valve dilation, patent ductus arteriosus closure, and Pott's anastomosis occlusion.
- TEE provided real-time monitoring of balloon placement, device deployment, and immediate results.
Main Results:
- TEE enabled precise guidance for balloon valvuloplasty and patent ductus arteriosus device placement.
- Real-time monitoring facilitated accurate assessment of procedural success and complications.
- A septic thrombus was detected in one severely ill patient, highlighting TEE's diagnostic value.
- Completeness of occlusion was confirmed using color Doppler via TEE.
Conclusions:
- Transesophageal echocardiography is a valuable tool for monitoring pediatric cardiac catheterization procedures.
- TEE enhances procedural accuracy, allows for immediate complication assessment, and can optimize outcomes.
- With further experience and smaller probes, TEE may become standard for monitoring even younger children, potentially reducing procedure time and contrast use.
Abstract:
Transesophageal echocardiography was performed in 51 children (aged 2 to 14 years, mean 4; weight 9 to 50 kg, mean 21) undergoing elective diagnostic or therapeutic cardiac catheterization. The interventional procedures were percutaneous balloon dilation of pulmonary (n = 8) and aortic (n = 2) valve stenosis, percutaneous closure of patent ductus arteriosus (n = 8), and attempted occlusion of Pott's anastomosis by the double umbrella device (n = 1). The diagnostic catheterizations were performed on preoperative children of whom 5 had undergone previous palliative procedures. Precise placement of the balloon across the valve, timing of balloon inflation and deflation according to real-time monitoring of ventricular function and immediate evaluation of results and complications were accomplished with transesophageal monitoring. The exact position of distal and proximal umbrellas of patent ductus occlusive devices was checked on transesophageal imaging and completeness of occlusion controlled on color Doppler. The only relevant information in the preoperative cases was the detection of a septic thrombus in a severely ill patient. With more experience and smaller probes, transesophageal echocardiography may become a new method of monitoring cardiac catheterization also in smaller children where it may reduce duration of the procedure and amount of contrast material.