DIAGNOSTIC-ACCURACY AND ROLE OF INTRAOPERATIVE BIPLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN PEDIATRIC-PATIENTS WITH LEFT-VENTRICLE OUTFLOW TRACT LESIONS

Objectives: To define the lesion-specific role of biplane transesophag eal echocardiography in children with left ventricular outflow tract o bstructive lesions, the diagnostic accuracy of transthoracic and trans esophageal images were compared, and the impact of transesophageal ech ocardiography on perioperative management was evaluated. Background: T he reported high postoperative recurrence of left ventricular outflow tract obstructive lesion can be due to its incomplete surgical relief. A full preoperative definition of the lesions would aid in better sur gical outcome. The complexity and spectrum of such lesions provide opp ortunity to evaluate the role of a recently available biplane transeso phageal pediatric probe in its diagnosis and surgical management. Meth ods: In 16 consecutive patients (11 male patients) with left ventricul ar outflow tract obstructive lesions and with a mean age of 7.9 +/- 5. 7 years (range 0.25 to 20.0 years) and a mean weight of 29 +/- 19 kg ( range 4 to 66 kg), the morphologic and hemodynamic findings of standar d preoperative transthoracic and intraoperative biplane transesophagea l echocardiography were compared with surgical and cardiac catheteriza tion findings (in seven patients) for the diagnostic accuracy and impa ct on the surgical management of the lesions. Results: Based on the le vels of agreement, transesophageal echocardiography demonstrated highe r diagnostic sensitivity (chi-squared analysis = 13.4 < 0.001) to the presence and extent of associated lesions (septal hypertrophy, multipl e fibromuscular insertions, involvement of aortic and mitral valves no t revealed by transthoracic imaging) and trend toward higher sensitivi ty (Fisher's exact p = 0.17) to primary morphologic diagnoses (abnorma l chordal attachments, prolapsed aortic cusp, and tunnel-like outflow tract obstructive lesions missed by transthoracic imaging). As a resul t of these factors, intraoperative transesophageal imaging changed the surgical plan in 25% of the patients and modified it in an additional 25% of the patients. Conclusions: Transesophageal echocardiography ca n be a reliable diagnostic tool and has an important role in the surgi cal management of left ventricular outflow tract lesions in children.