Evaluation of ventricular septal defect repair using intraoperative transesophageal echocardiography: Frequency and significance of residual defects in infants and children
Sg. Yang et al., Evaluation of ventricular septal defect repair using intraoperative transesophageal echocardiography: Frequency and significance of residual defects in infants and children, ECHOCARDIOG, 17(7), 2000, pp. 681-684
Citations number
7
Categorie Soggetti
Cardiovascular & Respiratory Systems
Journal title
ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES
Intraoperative transesophageal echocardiography (IOTEE) is commonly used to
assess for residual defect and the need to return to bypass after repair o
f ventricular septal defect (VSD). The frequency and significance of residu
al septal defects as noted on IOTEE has not been, well defined. We evaluate
d the frequency of residual VSD via IOTEE and the relationship between size
of a residual VSD and rate of reoperation. In addition, we looked at the r
elationship between, the presence of a residual VSD via IOTEE and the prese
nce of residual VSD at follow-up transthoracic echocardiography (TTE). Resi
dual VSD teas measured via the Largest width of the Doppler color jet diame
ter originating at the left ventricular septal surface. Of the 294 patients
evaluated with IOTEE after VSD repair, one-third had a residual defect by
IOTEE Doppler color flow mapping. Two-thirds of these defects closed sponta
neously on TTE by the time of hospital discharge. There was no difference i
n frequency of residual VSD between simple (VSD closure alone, n = 90) and
complex (VSD with associated lesions, n = 204) repair. Return to bypass wit
h immediate reoperation was undertaken in nine patients, all of whom had si
gnificant shunt via oximetry (Qp/Qs > 1.5:1.0). All had residual VSD color
jet diameters > 3 mm. Seven patients had residual color jet equal to 3 mm;
however, hemodynamic studies did not reveal a significant shunt and none of
these had reoperation. Seven, patients with no VSD or < 3 mm residual VSD
via had late reoperation to close residual VSD at 4 days to 5 months after
initial operation. These were due to patch dehiscence or development of an
"intramural" VSD in patients with conotruncal anomaly. A residual defect on
IOTEE color Doppler measuring <greater than or equal to> 4 mm predicts the
need for immediate reoperation, while a 3 mm defect may be significant and
requires additional intraoperative hemodynamic evaluation. The majority of
small defects noted on IOTEE are not present at discharge TTE. Patients wi
th conotruncal defect repair should be followed closely for development of
late significant "intramural" defects.