Doppler echocardiography with extended transesophageal atrial pacing: Predicting the efficacy of permanent atrial pacing in the patient with a small left ventricle and sinus node dysfunction

A 2100-g neonate underwent a two-ventricular surgical repair of a right ven tricle-dominant unbalanced atrioventricular septal defect associated with t he heterotaxy syndrome and sinus node dysfunction. Postoperative congestive heart failure persisted despite bradycardia management by temporary ventri cular pacing. Spectral Doppler echocardiographic analysis of pulmonary veno us inflow and aortic outflow patterns demonstrated significant improvement with transesophageal atrial pacing. Extended transesophageal pacing was per formed for two days, resulting in dramatic clinical improvement. This is th e first report of extended transesophageal atrial pacing complementing Dopp ler echocardiography predicting an improved outcome with permanent atrial p acing.