Abstract 1943: The Hemodynamic and Ventilation Effects of Miniaturized Multiplane Transesophageal Echocardiography in Small Infants Undergoing Cardiac Surgery
Background: Intraoperative transesophageal echocardiography (TEE) has been demonstrated to have a major impact in pediatric cardiac surgery. Leaving the operating room with residual defects is associated with increased morbidity, mortality and cost. There has been a reluctance to use TEE in small infants and neonates for concern of complications primarily related to transducer size. Paradoxically, it is the small neonate that has a lower tolerance for residual defects, and thus more to gain from TEE. Improved technology has led to a new miniaturized multiplane micro-TEE probe.
Objective: To assess the effects of the micro-TEE on hemodynamic and ventilation variables in small infants during cardiac surgery.
Methods: Infants ≤ 5 kg undergoing cardiac surgery were prospectively enrolled. Following the induction of general anesthesia, hemodynamic and ventilation parameters were recorded before and after micro-TEE insertion. After TEE assessment of the surgical repair and separation from cardiopulmonary bypass (CPB), the measurements were repeated before and after micro-TEE removal. Statistical analysis was performed using a two-tailed t-test.
Results: Ten patients were studied with a mean weight of 3.8 ± 0.7 kg (range 2.5 – 5 kg) and mean age of 2.1 ± 1.5 months (range 0.2 – 4 months). All insertions were successful. There were no complications or clinically significant changes in hemodynamic or ventilation parameters in the group as a whole or in any individual patient that could be attributed to the TEE. Residual defects that required return to CPB were identified in 20% of patients.
Conclusions: The micro-TEE provides high quality diagnostic images without hemodynamic or ventilation compromise in small infants. It plays a critical role in identifying residual cardiac defects, thus optimizing repairs and outcomes. This advance is important as there continues to be a growing trend towards complete repair of complex structural heart disease in small infants.