Atrial septal defect transesophageal echocardiography
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, M.B.B.S. [2], Cafer Zorkun, M.D., Ph.D. [3]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [4]
Overview
Transesophageal echocardiography (TEE) has had a notable positive impact on both, the care and management of a patient with congenital heart disease, such as an atrial septal defect patient. TEE has been evaluated in all age groups and is determined to be safe for pediatrics and adults.
Advantages
Combined with TTE, a TEE before cardiac surgery can:
- Confirm or exclude previous TTE findings
- Assess the immediate preoperative hemodynamics
- Assess ventricular function of the patient
- Facilitate placement of central venous catheters
- Assist with selection of anesthetic agents
- Be used as an inotropic support in identifying ventricular systolic size and function
After surgery but before closure, a TEE can:
- Improve overall outcome
- Assist in determining whether the level of repair is acceptable
- Detect and diagnose significant disease remaining to be treated
- Assess cardiac function
- Assess the presence of intracardiac air
- Diagnosis abnormal cardiac rhythms
- Monitor ventricular function and loading
- Provides a better imaging view for determination of appropriate timing and the hemodynamic effect of sternal closure
- Assist in monitoring inotropic drugs
In noncardiac procedures, TEE can:
- Enhance monitoring of mycardial function
- Enhance monitoring of volume status
Disadvantages
Constraints for testing include:
- Limited potential for optimal Doppler alignment
- Limited time to perform a complete study
- Suboptimal ambient lighting
Indications
TEE is a highly recommended method of imaging modality for atrial septal defect. It can provide:
- Precise identification of the location
- Bettered and more precise geometry
- Identifies the number of atrial septal defects
- Identifies the extend of surrounding atrial septal tissue
- Identifies the location of adjacent structures
This information allows an interventional cardiologist to determinbe the best method and devise for closure.[1]
TEE in Pediatrics
Research has indicated that TEE is a considerably safe procedure in pediatric populations. The reported incidence of development of complications during TEE performance is between 1-3%. Caution is recommended in inserting a probe into a neonate weigh less than or equal to 3 kg.[1] The most common complications include:
- Hoarseness
- Dysphagia
- Esophageal perforation
Less common complications:
- Perforation/laceration of the oropharynx, hypopharynx, esophagus and stomach
- Arrhythmias
- Pulmonary complications
- Bronchospasm
- Hypoxemia
- Laryngospasm
- Circulatory derangement
- Endocarditis
Clinical Recommendations
The Task Force of the Pediatric Council of the American Society of Echocardiography recommends that: {{cquote| A preoperative transthoracic echocardiogram be performed in every patient undergoing a transesophageal echocardiogram during congenital heart surgery. The results of the TTE should be evaluated prior to the TEE. A TEE is not recommended as the only diagnostic imagining method as there are limitations that are better identified in methods such as TTE.[1]}
References
- ↑ 1.0 1.1 1.2 Ayres NA, Miller-Hance W, Fyfe DA, Stevenson JG, Sahn DJ, Young LT; et al. (2005). "Indications and guidelines for performance of transesophageal echocardiography in the patient with pediatric acquired or congenital heart disease: report from the task force of the Pediatric Council of the American Society of Echocardiography". J Am Soc Echocardiogr. 18 (1): 91–8. doi:10.1016/j.echo.2004.11.004. PMID 15637497.