Initial experience with a miniaturized multiplane transesophageal probe in small infants undergoing cardiac operations

Abstract

Purpose: There has been reluctance to use intraoperative transesophageal echocardiography (TEE) in small infants. We assessed the utility and safety of a new miniaturized multiplane micro-TEE probe in small infants undergoing cardiac operations.

Description: Hemodynamic and ventilation variables were prospectively recorded before and after micro-TEE insertion and removal in infants weighing 5 kg or less undergoing cardiac operations.

Evaluation: The study included 42 patients with a mean weight of 3.6 +/- 0.9 kg (range, 1.7 to 5 kg). All probe insertions were successful. There were no complications or clinically significant changes in hemodynamic or ventilation variables. Information provided by TEE resulted in surgical revision in 6 of the 42 patients.

Conclusions: The micro-TEE provides high quality, useful diagnostic images without hemodynamic or ventilation compromise in small infants undergoing cardiac operations. This advance is important with the growing trend towards complete repair of complex structural heart disease in small infants.

Fig 1

Dimensions of the micro-multiplane transesophageal echocardiography probe.

Fig 2

This image was obtained in a 3-monthold, 5-kg infant with atrioventricular septal defect and severe left-sided atrioventricular valve regurgitation. In addition to closing the cleft, the surgeon created a double-orifice left atrioventricular valve. This 60° image of the surgically created double-orifice mitral valve demonstrates prograde flow thorough both orifices. (LA = left atrium; LV = left ventricle.)

Fig 3

Simultaneous (A) 2-dimensional and (B) color-flow Doppler images are shown in a 1-week-old, 3.7-kg infant undergoing repair of truncus arteriosus. There is right to left flow across the ventricular septal defect (asterisk). Note the very short-segment of the main pulmonary artery arising from the truncal root (T), before bifurcating into the right (R) and left (L) pulmonary arteries. (LA = left atrium; RV = right ventricle.)

Fig 4

Simultaneous (A) 2-dimensional and (B) color-flow Doppler images are shown in a 3-week-old, 2.8-kg neonate undergoing repair of a membranous ventricular septal defect. Preoperative transthoracic imaging raised concerns for potential tricuspid valve straddling. Transesophageal imaging demonstrated no chordal tissues crossed the ventricular septum, and a complete repair was performed. Notice the redundant tricuspid valve tissue obscuring the defect on 2-dimensional imaging; however, the defect is clearly seen with color Doppler (black asterisk). There is mild nonobstructive anterior malalignment of the infundibular septum (white asterisk). (AO = aorta; PA = pulmonary artery; RV = right ventricle.)