Cairo University, Cairo, Egypt.
Ann Thorac Surg. 2010 Apr;89(4):1233-7. doi: 10.1016/j.athoracsur.2009.10.058.
Intraoperative transesophageal echocardiography (IOTEE) is well established as a monitoring tool during ventricular septal defect (VSD) repair to ensure complete closure of the defect. Residual shunts detected by IOTEE are common. The predictive value of IOTEE findings on the long-term course of residual shunts is not well documented, especially in regard to the need for reoperation or bacterial endocarditis prophylaxis. The objective of this study is to determine the predictive value of intraoperative IOTEE diagnosis of residual VSDs and therefore delineating the natural history of these findings.
Retrospective review of IOTEE reports of 690 consecutive patients with VSD (isolated or part of a complex lesion) was undertaken. Those were compared with transthoracic echocardiographic reports of these patients before their discharge from the hospital, and the most recent transthoracic echocardiographic examination. Positive and negative predictive values, sensitivity, and specificity of such diagnoses were then calculated from predischarge and from follow-up transthoracic echocardiographic data.
There were 260 of 690 patients with a residual VSD on IOTEE; 24 required repeat cardiopulmonary bypass for complete closure. There were 573 patients with predischarge transthoracic echocardiographic examination; 296 had residual VSDs (125 not detected by IOTEE), and 13 defects required reoperation during the same hospitalization, 5 of which were detected by IOTEE. The positive and negative predictive values were 78% and 65%, respectively. Follow-up transthoracic echocardiographic examination of 383 local patients showed residual VSD in 57 (37 not detected by IOTEE), with positive and negative predictive values of 15% and 83%, respectively.
Although IOTEE is sensitive enough to detect residual VSD shunts in many patients (37% of this cohort), the majority of these defects are trivial and resolve spontaneously, with a positive predictive value of only 15% on follow-up transthoracic echocardiographic examination and a rare need for reoperation.
术中经食管超声心动图（IOTEE）已被确立为室间隔缺损（VSD）修复期间的监测工具，以确保缺损完全闭合。通过 IOTEE 检测到的残余分流很常见。IOTEE 检查结果对残余分流的长期病程的预测价值尚未得到很好的记录，特别是在需要再次手术或预防细菌性心内膜炎方面。本研究的目的是确定术中 IOTEE 诊断残余 VSD 的预测价值，从而描绘这些发现的自然病史。
对 690 例连续 VSD（单纯或复杂病变的一部分）患者的 IOTEE 报告进行回顾性分析。将这些报告与这些患者出院前的经胸超声心动图报告以及最近的经胸超声心动图检查进行比较。然后，根据出院前和随访经胸超声心动图数据计算此类诊断的阳性和阴性预测值、敏感性和特异性。
690 例患者中有 260 例 IOTEE 显示残余 VSD；24 例需要再次心肺转流以完全闭合。573 例患者出院前进行了经胸超声心动图检查；296 例有残余 VSD（125 例未被 IOTEE 检测到），其中 13 例在同一住院期间需要再次手术，其中 5 例被 IOTEE 检测到。阳性和阴性预测值分别为 78%和 65%。对 383 例本地患者的随访经胸超声心动图检查显示，57 例有残余 VSD（37 例未被 IOTEE 检测到），阳性和阴性预测值分别为 15%和 83%。
尽管 IOTEE 足够敏感，可以检测出许多患者（本队列的 37%）中的残余 VSD 分流，但大多数这些缺陷都是微不足道的，会自行解决，随访经胸超声心动图检查的阳性预测值仅为 15%，且很少需要再次手术。
