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Intraoperative epicardial echocardiography in assessing pulmonary artery banding procedures
N Sreeram1, R Jagtap, E D Silove
1Heart Unit, Children's Hospital, Birmingham, England.
Insights
Epicardial Doppler echocardiography offers accurate assessment of pulmonary artery banding adequacy in infants. This method aids in optimal band positioning and effective pressure gradient adjustment during surgery.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Medical Imaging
Background:
- Traditional methods for assessing pulmonary artery banding adequacy include oximetry and direct pressure measurements.
- Epicardial Doppler echocardiography presents a novel approach for evaluating banding procedures.
Purpose of the Study:
- To evaluate the utility of intraoperative epicardial Doppler echocardiography in assessing pulmonary artery banding.
- To determine if this imaging modality can confirm optimal band placement and guide adjustments.
Main Methods:
- Six infants undergoing pulmonary artery banding for complex heart defects were studied using intraoperative epicardial Doppler echocardiography.
- The technique allowed visualization of the band's relation to the pulmonary valve and branch arteries.
Main Results:
- Epicardial echocardiography provided excellent visualization, confirming optimal band positioning in all patients.
- Pressure drop estimation across the band was successful, leading to further band tightening in 33% of patients.
- Intraoperative transband pressure gradients correlated well with subsequent transthoracic echocardiography measurements.
Conclusions:
- Epicardial echocardiography is a valuable tool for perioperative assessment of pulmonary artery banding.
- It serves as an adjunct to existing methods, improving band size adjustment and placement accuracy.
Background:
Accurate perioperative assessment of the adequacy of pulmonary artery banding has hitherto relied on oximetry and direct pressure measurements. We report the use of epicardial Doppler echocardiography for assessing banding procedures.
Methods:
Six consecutive infants (3 male, 3 female; median age, 17 days) who underwent pulmonary artery banding for complex defects were studied by intraoperative epicardial Doppler echocardiography.
Results:
Excellent visualization of the relation of the band to the pulmonary valve and branch arteries was obtained, enabling or confirming optimal positioning. Doppler echocardiographic estimation of the pressure drop across the band was possible in each patient and resulted in further tightening of the band in 2 patients (33%) with satisfactory increases in transband pressure gradients. Intraoperative echocardiographic estimates of the transband gradients (median, 57 mm Hg; range, 52 to 71 mm Hg; mean +/- standard deviation, 59 +/- 7 mm Hg) correlated well with those obtained at subsequent transthoracic echocardiography (median gradient, 66 mm Hg; range, 52 to 67 mm Hg; mean +/- standard deviation, 63 +/- 6 mm Hg).
Conclusions:
Epicardial echocardiography is a valuable adjunct to direct pressure and saturation measurements for adjustment of final band size and aids in confirming accurate band placement.