Reliability of intraoperative transesophageal echocardiography during tetralogy of fallot repair

There is limited information available concerning the accuracy of intraoper ative transesophageal echocardiography (TEE) in predicting the extent of re sidual abnormalities after recovery from surgical repair of tetralogy of Fa llot. Therefore, we investigated differences between, the results of final postbypass TEE and those of postrecovery (mean, 6 days after surgery) trans thoracic echocardiography in a total of 28 consecutive pediatric patients w ho underwent repair of tetralogy of Fallot with biplane or multiplane TEE. Both postbypass and postrecovery echocardiographic examinations included me asurements of the right ventricle (RV)-main pulmonary artery (PA) and the m ain PA-branch PA peak instantaneous gradients, the degree of pulmonary valv ar insufficiency, and color Doppler interrogation of the ventricular septum for residual defects. The RV-main PA gradient did not change significantly : 15 +/- 13 us 18 +/- 14 mmHg (postbypass versus postrecovery, mean +/- SD) . None of the patients had a decrease of greater than or equal to 10 mmHg; and only one patient had an increase of greater than or equal to 15 mmHg. T here also was no change in the degree of pulmonary insufficiency (3.0 +/- 1 .2 versus 3.1 +/- 1.1, using a scale of 0 to 4). Only one of the seven very smalt (less than or equal to 2 mm) residual ventricular septal defects was not discovered during postbypass TEE. However, postrecovery transthoracic echocardiography detected significant branch PA stenosis (peak gradient, gr eater than or equal to 15 mmHg) in five patients (18%) that was not detecte d during postbypass TEE (P < 0.03). Of the blanch PA stenoses that were not detected during TEE, four were Left and one teas right. Conclusions: Postb ypass TEE after tetralogy of Fallot repair reliably predicts residual postr ecovery, hemodynamic abnormalities, except for branch PA stenosis.