Accuracy of transesophageal echocardiography in the identification of postoperative intramural ventricular septal defects.

TitleAccuracy of transesophageal echocardiography in the identification of postoperative intramural ventricular septal defects.
Publication TypeJournal Article
Year of Publication2016
AuthorsPatel JK, Glatz AC, Ghosh RM, Jones SM, Ravishankar C, Mascio C, Cohen MS
JournalJ Thorac Cardiovasc Surg
Volume152
Issue3
Pagination688-95
Date Published2016 09
ISSN1097-685X
KeywordsCardiopulmonary Bypass, Echocardiography, Echocardiography, Transesophageal, Female, Heart Defects, Congenital, Heart Septal Defects, Ventricular, Humans, Infant, Infant, Newborn, Male, Postoperative Complications, Reoperation, Retrospective Studies, Sensitivity and Specificity
Abstract

BACKGROUND: Intramural ventricular septal defects (VSDs), residual interventricular communications occurring after repair of conotruncal defects, are associated with poor postoperative outcomes. The ability of intraoperative transesophageal echocardiography (TEE) to identify intramural VSDs has not yet been evaluated.

METHODS: Intraoperative TEE and postoperative transthoracic echocardiography (TTE) data in all patients undergoing all biventricular repair of conotruncal anomalies in our hospital between January 1, 2006, and June 30, 2013, were reviewed. The ability of TEE to accurately identify residual defects was assessed using postoperative TTE as the reference imaging modality.

RESULTS: Intramural VSDs occurred in 34 of 337 patients evaluated; 19 were identified by both TTE and TEE, and 15 were identified by TTE only. Sensitivity was 56% and specificity was 100% for TEE to identify intramural VSDs. Peripatch VSDs were identified in 90 patients by both TTE and TEE, in 53 by TTE only, and in 15 by TEE only, yielding a sensitivity of 63% and specificity of 92%. Of the VSDs requiring catheterization or surgical reintervention, 6 of 7 intramural VSDs and all 5 peripatch VSDs were identified by intraoperative TEE. TEE guided the intraoperative decision to return to cardiopulmonary bypass (CPB) in an attempt to close residual defects in 12 patients with intramural VSDs and in 4 patients with peripatch VSDs seen after initial CPB; of these, 10 intramural VSDs and all 4 peripatch VSDs resolved or became smaller on final intraoperative TEE.

CONCLUSIONS: TEE has modest sensitivity but high specificity for identifying intramural VSDs and can detect most defects requiring reintervention. Repeat attempts at closure in the index operation may successfully correct intramural VSDs identified by TEE.

DOI10.1016/j.jtcvs.2016.04.026
Alternate JournalJ. Thorac. Cardiovasc. Surg.
PubMed ID27183884
Grant ListT32 HL007915 / HL / NHLBI NIH HHS / United States