DETECTION OF RESIDUAL FLOW BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY DURINGVIDEO-ASSISTED THORACOSCOPIC PATENT DUCTUS-ARTERIOSUS INTERRUPTION

The purpose of this study is to examine prospectively the efficacy of intraoperative transesophageal echocardiography (TEE) monitoring in re ducing the incidence of residual ductal flow during video-assisted tho racoscopic (VATS) patent ductus arteriosus (PDA) interruption. Thirty consecutive patients undergoing PDA interruption via the VATS procedur e were monitored with an appropriately sized Hewlett-Packard color-Dop pler TEE probe. All examinations were performed by the same individual and interpreted with a cardiologist. Real time TEE monitoring was use d, but the results were not disclosed to the surgeon until he was prep ared to close the wound. The mean age was 2.4 yr and the average weigh t 11.2 kg. Two patients had residual flow after placement of the vascu lar clip. One patient had residual flow detected intraoperatively afte r placement of the vascular clip and residual flow was quickly abolish ed by the placement of a second clip, thus avoiding a reintervention. A follow-up transthoracic echocardiography was performed on 18 patient s 1 mo postoperatively Three patients presented residual ductal flow. This study using a novel application of TEE, demonstrates that TEE mon itoring during PDA interruption may improve the surgical result, thus avoiding reintervention and the complications associated with residual ductal flow. However, late recurrence due to recanalization may occur and may not be detected by intraoperative TEE monitoring.