INTRAOPERATIVE ECHOCARDIOGRAPHY DURING CONGENITAL HEART OPERATIONS - EXPERIENCE FROM 1,000 CASES

Background. This article provides an overview of the application of in traoperative echocardiography during repair of congenital heart defect s based on our experience with 1,000 patients. Methods. The patients i n this study all underwent repair of a congenital heart defect between 1987 and 1994 at Duke University Medical Center. Echocardiography was performed on all patients in the operating room both before and after repair using epicardial or transesophageal imaging (or both). Hospita l costs and outcome data were obtained for all patients. Results. Over all, 44 patients (4.4%) underwent intraoperative revision of their rep air based on echocardiographic findings. There was an initial learning phase during which 8.5% of repairs needed to be revised. With experie nce, the number of revisions fell to as low as 3% to 4%, but need for revision continued to occur throughout the series. Thirty-nine patient s (88.6%) had a successful revision. It was not possible for the surge on to predict the need for a revision based on his confidence in the r epair: in 2.6% of patients thought by the surgeon to have a good repai r, intraoperative echocardiography revealed the need for operative rev ision. The average cost for patients who return to the operating room during their hospitalization for revision of a repair is significantly greater than for those whose repairs are revised before they leave th e operating room ($94,180.28 +/- $33,881.63 versus $21,415.79 +/- $8,2 15.74). There were no significant complications attributable to intrao perative echocardiography. Conclusions. In an era where complete repai r of congenital heart defects is emphasized, intraoperative echocardio graphy provides information that can guide successful operative revisi on so that babies leave the operating room with optimal results.