ROUTINE USE OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY AND COLOR-FLOW IMAGING IN THE EVALUATION AND TREATMENT OF CHILDREN WITH CONGENITAL HEART-DISEASE

We reviewed our experience with transesophageal echocardiography (TEE) and color flow imaging in 157 consecutive patients with known. or sus pected heart disease to ascertain. the impact of this technology on pa tient care. TEE was performed for diagnostic purposes (22/157), during interventional cardiac catheterizations (13/157), and during operativ e procedures (122/157). Diagnostic studies were performed after transt horacic echocardiography (TTE) in 21 of 22 patients. TEE was performed because TTE was inconclusive (15/21) or failed to provide sufficient detail of an abnormality (6/21). TEE detected an abnormality in 6 of 1 5 inconclusive TTEs. TEE was helpful during interventional cardiac cat heterizations, particularly during umbrella closure of septal defects and in patients with complex venous and atrial anatomy undergoing tran sseptal puncture. TEE studies performed before cardiac operations sign ificantly changed the diagnosis in only 5 of 122 (4%) patients, but th e information changed the surgical approach in 4 of 5 of these patient s. Postoperative TEE assessment more frequently changed care and resul ted in further surgical management in 9 of 122 (7%) or a change in med ical management in 6 of 122 (5%) patients. TEE was discontinued becaus e of complications before studies were completed in only 4 of 157 (3%) patients. TEE and color flow imaging is a useful adjunct to care of c hildren with known or suspected congenital heart disease.