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Ann Thorac Surg 2005;80:56-59
© 2005 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Predictive Value of Intraoperative Transesophageal Echocardiography in Complete Atrioventricular Septal Defect

^a Department of Thoracic and Cardiovascular Surge ry, Department of Pediatrics,Sejong General Hospital, Sejong Heart Institute, Bucheon, Korea
^b Department of Thoracic and Cardiovascular Surgery, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea, Korea

Accepted for publication January 20, 2005.

^_* Address reprint requests to Dr Woong-Han Kim, Department of Thoracic and Cardiovascular Surgery, Clinical Research Institute, Seoul National University, College of Medicine, Seoul National University Children’s Hospital, 28 Yongon-Dong, Jongno-Gu, Seoul, 110-744, Korea; (Email: woonghan{at}korea.com).

BACKGROUND: Intraoperative transesophageal echocardiography and follow-up transthoracic echocardiography have been useful in assessing cardiac function in complete atrioventricular septal defects. However, it has been suggested that a discrepancy exists between intraoperative and postoperative findings, and that intraoperative findings cannot reliably predict long-term results. This study aims to determine whether this discrepancy exists and to assess whether it is possible to predict follow-up results using intraoperative transesophageal echocardiography.

METHODS: A retrospective analysis was made in 35 patients who underwent biventricular repair by one surgeon between November 1997 and January 2004. All patients received intraoperative transesophageal echocardiography and follow-up transthoracic echocardiography at 19.1 ± 18.02 months (range, 7 days to 5 years; median, 15.1 months).

RESULTS: In left-sided atrioventricular valve regurgitation, 34.3% (12 of 35) of patients showed discrepancy during follow-up, and 28.6% (10 of 35) showed progression of regurgitation (from grade I to II). In right-sided atrioventricular valve, 11.4% (4 of 35) of patients showed discrepancy, 9.6% (3 of 35) showed progression of regurgitation (from grade I to II).

CONCLUSIONS: In complete atrioventricular septal defects, intraoperative transesophageal echocardiography did not show the same findings as that of follow-up transthoracic echocardiography in some cases. However, this discrepancy is not so great as to require reoperation in early to midterm follow-up. Therefore, intraoperative transesophageal echocardiography may be used as tool to predict durability of surgical results and to decrease the incidence of reoperation in complete atrioventricular septal defects.

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Invited commentary

Richard Mainwaring
Ann. Thorac. Surg. 2005 80: 59. [Extract] [Full Text] [PDF]

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