Guzeltas Alper, Ozyilmaz Isa, Tanidir Cansaran, Odemis Ender, Tola Hasan Tahsin, Ergul Yakup, Bilici Meki, Haydin Sertac, Erek Ersin, Bakir Ihsan
Department of Pediatric Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey.
Congenit Heart Dis. 2014 Jul-Aug;9(4):300-6. doi: 10.1111/chd.12139. Epub 2013 Sep 19.
The rapid expansion of pediatric cardiovascular surgery, along with the increase in the number of centers and operations, has also increased the use of intraoperative transesophageal echocardiography (TEE). Preoperative TEE allows for the confirmation of diagnoses established by transthoracic echocardiography and angiography, and also identifies possible additional pathologic conditions. TEE is also used to follow up on surgical repairs, determine the need for reintervention, and evaluate myocardial performance and the need for inotropic treatment. Our intention is to share the TEE findings before and after intervention for congenital heart disease in patients who received operations at our center, and the conclusions reached.
From October 2009 to February 2013, 1008 patients underwent surgery for congenital heart disease. Of these, 265 were subjected to TEE in the operating room. Each patient entering the operating room with TEE planned had the echocardiography probe placed while intubated under general anesthesia. TEE studies used a GE Vivid S5. Different investigations, according to the patients' particular pathologic conditions, were also performed in addition to standard TEE studies.
Of the 265 patients for whom surgery was indicated by transthoracic echocardiography and other appropriate examinations, 260 had the diagnosis confirmed by preoperative TEE and the indicated intervention was performed. For the remaining 5 patients (1.8%), the intervention plan was changed following preoperative TEE. Cardiopulmonary bypass was reinitiated in 12 (4.5%) patients because of residual defects identified by postoperative TEE. Thus, the preoperative plan was changed in 17 (6.4%) patients out of a total of 265 owing to preoperative and postoperative TEE findings.
The use of intraoperative TEE in surgical centers for congenital heart disease allows for a significant reduction in mortality and morbidity. Intraoperative TEE performed by experienced pediatric cardiologists is therefore an absolute necessity.
小儿心血管外科的迅速发展，以及手术中心数量和手术量的增加，也使得术中经食管超声心动图（TEE）的使用增多。术前TEE可用于确认经胸超声心动图和血管造影所确立的诊断，还能发现可能存在的其他病理状况。TEE也用于对手术修复情况进行随访、确定再次干预的必要性、评估心肌功能以及判断是否需要进行强心治疗。我们旨在分享在本中心接受手术的先天性心脏病患者干预前后的TEE检查结果以及得出的结论。
2009年10月至2013年2月，1008例患者接受了先天性心脏病手术。其中，265例在手术室接受了TEE检查。每例计划在手术室进行TEE检查的患者在全身麻醉插管时放置超声心动图探头。TEE检查使用GE Vivid S5型设备。除了标准的TEE检查外，还根据患者的具体病理状况进行了不同的检查。
在经胸超声心动图和其他适当检查提示需要手术的265例患者中，260例经术前TEE确诊并进行了指定的干预。其余5例（1.8%）患者在术前TEE检查后改变了干预计划。12例（4.5%）患者因术后TEE发现残余缺陷而重新进行了体外循环。因此，由于术前和术后TEE检查结果，在总共265例患者中有17例（6.4%）改变了术前计划。
在先天性心脏病手术中心使用术中TEE可显著降低死亡率和发病率。因此，由经验丰富的小儿心脏病专家进行术中TEE检查是绝对必要的。
