Can intraoperative TEE correctly measure residual shunt after surgical repair of ventricular septal defects?

• Published in: Journal of anesthesia 2010-06, Vol.24 (3), p.343-350
• Main Authors: Kurokawa, Satoshi, Honma, Takayuki, Taneoka, Miki, Imai, Hidekazu, Baba, Hiroshi, Nomura, Minoru
• Format: Article
• Language: English
• Subjects: Adolescent; Algorithms; Anesthesiology; Arteriovenous Shunt, Surgical; Blood Gas Analysis; Cardiac Catheterization; Child; Child, Preschool; Coronary artery bypass; Critical Care Medicine; Echocardiography, Transesophageal; Electrocardiography; Emergency Medicine; Female; Follow-Up Studies; Heart Septal Defects, Ventricular - diagnostic imaging; Heart Septal Defects, Ventricular - surgery; Humans; Image Processing, Computer-Assisted; Infant; Intensive; Male; Measurement; Medicine; Medicine & Public Health; Original Article; Pain Medicine; Pulmonary Circulation - physiology; Reoperation; Ventricular septal defects; Young Adult
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-010-0896-3

Purpose No groups have yet succeeded in identifying the need for re-repair of residual shunt after surgical repair of ventricular septal defect (VSD) based on quantitative evaluation of the ratio of the pulmonary blood flow to the systemic blood flow (Qp/Qs) by transesophageal echocardiography (TEE). Hence, we studied the accuracy of Qp/Qs as estimated by intraoperative TEE. Methods Twenty-six patients undergoing VSD closure were studied. After separation from the cardiopulmonary bypass, the presence and severity of residual leakage was evaluated by color Doppler image, and the Qp/Qs (TEE-derived Qp/Qs) was calculated by measuring the vessel diameter and the velocity–time integral of the flow profiles in the main pulmonary artery and left ventricular outflow tract. Transthoracic echocardiography (TTE) was performed at pre-discharge and at 6–12 months after the correction to confirm the presence and severity of residual leakage. Results TEE detected only minor leakage, with no indication for re-repair, in 8 of the 26 patients. Nevertheless, TEE-derived Qp/Qs varied from 0.57 to 2.07 and were incorrect in 17 patients (65.4%). This meant that when TEE-derived Qp/Qs was outside the acceptable range, the patient was judged not to be in need of re-repair. TTE at pre-discharge confirmed trivial leakage in 3 patients in whom TEE had also identified similar leakages. These leakages were not observed at the follow-up TTE. Conclusion TEE-derived Qp/Qs lacks the accuracy required to play a crucial role in quantitatively measuring the severity of residual shunt, while two-dimensional TEE can reliably detect residual leakage after VSD closure and lead to optimal judgment on the need for re-repair.