Sawda Christine, Henmi Soichiro, Dwivedi Pallavi, Haverty Mitchell, d'Udekem Yves, Loke Yue-Hin, Udine Michelle
Divisions of Cardiology, Children's National Hospital, The George Washington University School of Medicine and Health Science, Washington, DC, USA.
Children's National Hospital, Children's National Heart Institute, The George Washington University School of Medicine and Health Science, 111 Michigan Ave, NW, Washington, DC, 20010, USA.
Int J Cardiovasc Imaging. 2025 Feb;41(2):237-245. doi: 10.1007/s10554-024-03302-9. Epub 2024 Dec 13.
Post-operative transesophageal echocardiography (TEE) is standard of care to evaluate for residual disease and quality of surgical repair. The residual lesion score (RLS) as defined by the pediatric heart network explored the impact of residual lesions on outcomes using discharge transthoracic echocardiogram (TTE). In tetralogy of fallot with pulmonary stenosis (TOF/PS), the residual right ventricular outflow tract (RVOT) gradient is one marker of quality of repair. Given peri-operative differences in hemodynamics, this study aims to define the correlation between TEE and discharge TTE RVOT gradient. This single center retrospective study included patients with TOF/PS undergoing primary repair with accompanying perioperative TEE and discharge TTE. TEE and TTE measurements were compared. An RLS based on the type of repair was assigned to the post-operative TEE based on the RVOT doppler velocity. TEE RVOT peak velocity and VTI correlated with TTE RVOT peak velocity (Spearman rank correlation coefficient = 0.62 (p < 0.001)) and VTI (Spearman rank correlation coefficient = 0.66 (p < 0.001)) at time of discharge. Application of RLS at the time of the TEE does not accurately reflect RLS at the time of discharge based on current criteria (p-value based on McNemar's Chi-squared test = 0.24). The ability of post-op TEE measurement to predict need for re-intervention is just as effective as TTE. On ROC analysis, the TEE RVOT peak velocity had similar AUC (0.672) compared to discharge TTE RVOT peak velocity (0.721) on predicting need for re-intervention. After surgical repair of TOF/PS, there is a strong correlation between post-op TEE and discharge RVOT peak velocity. TEE offers a chance to guide immediate re-intervention if needed and may be applied to severe residual post-op RVOT peak velocity. Further studies are needed to identify RLS based on TEE and its relationship to outcomes and intraoperative management.
术后经食管超声心动图（TEE）是评估残余疾病和手术修复质量的标准治疗手段。儿科心脏网络定义的残余病变评分（RLS）使用出院时的经胸超声心动图（TTE）探讨了残余病变对预后的影响。在法洛四联症合并肺动脉狭窄（TOF/PS）中，残余右心室流出道（RVOT）梯度是修复质量的一个指标。鉴于围手术期血流动力学的差异，本研究旨在确定TEE与出院时TTE测量的RVOT梯度之间的相关性。这项单中心回顾性研究纳入了接受初次修复的TOF/PS患者，并伴有围手术期TEE和出院时TTE检查。对TEE和TTE测量结果进行了比较。根据RVOT多普勒速度，基于修复类型为术后TEE指定了一个RLS。出院时，TEE的RVOT峰值速度和VTI与TTE的RVOT峰值速度（斯皮尔曼等级相关系数 = 0.62（p < 0.001））和VTI（斯皮尔曼等级相关系数 = 0.66（p < 0.001））相关。根据当前标准，在TEE检查时应用RLS并不能准确反映出院时的RLS（基于麦克尼马尔卡方检验的p值 = 0.24）。术后TEE测量预测再次干预需求的能力与TTE一样有效。在ROC分析中，TEE的RVOT峰值速度在预测再次干预需求方面与出院时TTE的RVOT峰值速度（0.721）具有相似的曲线下面积（AUC，0.672）。在TOF/PS手术修复后，术后TEE与出院时RVOT峰值速度之间存在很强的相关性。如果需要，TEE为指导立即再次干预提供了机会，并且可应用于严重的术后RVOT残余峰值速度。需要进一步研究以基于TEE确定RLS及其与预后和术中管理的关系。
