Abstract
Background and hypothesis: Transesophageal echocardiography (TEE) is increasingly utilized for the monitoring of interventional cardiac catheterization in children. The initial nondiscriminant use is giving way to a more selective approach. The current role and usefulness of this imaging modality are described.
Methods: Between 1991 and 1995, 44 patients (mean age 7.4 ± 5 years, weight 22.8 ± 14.2 kg) underwent interventional cardiac catheterizations performed under TEE monitoring. The interventional procedures included (1) those involving creation, enlargement, or closure of an interatrial communication; (2) balloon dilatation of stenotic lesions; and (3) occlusion of arterial ducts. Transesophageal echocardiographic monitoring was judged to be either of great value, contributory, or of little use if the interventional procedure and choice of instrument relied heavily upon, was guided, or not affected by the information obtained from the ultrasonic investigation, respectively.
Results: Transesophageal echocardiography was judged to be of great value in the monitoring of 18 (40%) procedures involving either the creation, enlargement, or closure of interatrial communications. This included 4 transseptal punctures, 4 blade septectomies for relieving restrictive atrial septal defects (n = 3) and an enlargement of the communication between the superior and inferior chambers of the divided left atrium in cortriatriatum, and 11 closures of a secundum atrial septal defect. Only the ultrasonic monitoring could clearly visualize the interatrial partition to provide real‐time guidance on the positioning of the instrument to carry out the invasive procedures. Transesophageal echocardiography provided clear images of the hinge points of the aortic and mitral valves, the dimension of the narrowed pulmonary venous pathway in patients after venous switch operation. This facilitated the choice of the correct size of the balloon for dilatation in 11 patients (24%) and provided immediate postdilatation hemodynamic assessment. As for balloon dilation of subvalvar ventricular outflow tract obstruction (n = 3), aortic coarctation (n = 6), and occlusion of persistent arterial duct (n=7), TEE offered no obvious advantage over fluoroscopy with angiography. The monitoring was judged to be of little value for the 16 (36%) procedures.
Conclusion: Transesophageal echocardiographic monitoring is of great value in interventional procedures involving the atrial septum and enhances interventional procedures involving obstructive lesions of the left heart in children.
Keywords: transesophageal echocardiography, interventional catheterizations, children
Full Text
The Full Text of this article is available as a PDF (1.5 MB).
References
- 1. Boutin C, Dyck J, Beeson L, Houde C, Freedom RM: Balloon atrial septostomy under transesophageal echocardiographic guidance. Pediatr Cardiol 1992; 13: 176–177 [DOI] [PubMed] [Google Scholar]
- 2. Ishii M, Kato H, Inoue O, Takagi J, Maeno Y, Sugimuna T, Miyake T, Kumato M, Kosuga K, Ohishi K: Biplane transesophageal echo — Doppler studies of atrial septal defects: Quantitative evaluation and monitoring for transcatheter closure. Am Heart J 1993; 125: 1363–1368 [DOI] [PubMed] [Google Scholar]
- 3. Ballal RS, Mahah EF III, Nanda NC, Dean LS: Utility of transesophageal echocardiography in interatrial septal puncture during percutaneous mitral balloon commissurotomy. Am J Cardiol 1990; 66: 230–232 [DOI] [PubMed] [Google Scholar]
- 4. Vialscosta I, Iturralde E, San Roman JA, Gomez‐Recio M, Romero C, Jimenez J, Martinez‐Elbal L: Transesophageal echocardiographic monitoring of percutaneous mitral balloon valvulotomy. Am J Cardiol 1992; 70: 1040–1044 [DOI] [PubMed] [Google Scholar]
- 5. Stumper O, Witsenberg M, Sutherland G, Crommo‐Dijkhuis A, Godman M, Hess J: Transesophageal echocardiographic monitoring of interventional cardiac catheterization in children. J Am Coll Cardiol 1991; 15: 1506–1514 [DOI] [PubMed] [Google Scholar]
- 6. Tumbarello R, Sanna A, Cardu G, Bande A, Napoleone A, Bini RM: Usefulness of transesophageal echocardiography in the pediatric catheterization laboratory. Am J Cardiol 1993; 71: 1321–1325 [DOI] [PubMed] [Google Scholar]
- 7. Tong AD, Rothman A, Shiota T, Rice M, Blanchard DG, Hellenbrand W, Sahn DJ: Interventional cardiac catheterization under transesophageal echocardiographic guidance. Am Heart J 1995; 129: 827–831 [DOI] [PubMed] [Google Scholar]
- 8. Sideris EB, Sideris SE, Fowlkes JP, Ehly RL, Smith JE, Guide RE: Transcutaneous atrial septal defect occlusion in piglets with a “buttoned” double‐disk device. Circulation 1990; 81: 312–318 [DOI] [PubMed] [Google Scholar]
- 9. Leung MP, Yung TC, Chan B, Chiu C, Lee J, Mok CK: The role of transesophageal echocardiography in the diagnosis and management of children and young adults with valvar diseases of the left heart. Cardiol Young 1994; 4: 373–380 [Google Scholar]
- 10. Ballal RS, Mahan EF III, Nanda NC, Dean LS: Utility of transesophageal echocardiography in interatrial septal puncture during percutaneous mitral balloon commissurotomy. Am J Cardiol 1990; 66: 230–232 [DOI] [PubMed] [Google Scholar]
- 11. Vilacosta I, Iturralde E, San Roman JA, Gomez‐Recio M, Romero C, Jimenez J, Martinez‐Elbal L: Transesophageal echocardiographic monitoring of percutaneous mitral balloon valvotomy. Am J Cardiol 1992; 70: 1040–1044 [DOI] [PubMed] [Google Scholar]
- 12. Hosking MCK, Aliheri M, Murdison KA, Teixeira OHP, Ducan WJ: Transcatheter management of pulmonary venous pathway obstruction with atrial baffle leak following Mustard and Senning operation. Cathet Cardiovasc Diagn 1993; 30: 76–82 [DOI] [PubMed] [Google Scholar]
- 13. Van Der Velde ME, Sanders SP, Keane JF, Perry SB, Lock JE: Transesophageal echocardiographic guidance of transcatheter ventricular septal defect closure. J Am Coll Cardiol 1994; 23: 1660–1665 [DOI] [PubMed] [Google Scholar]