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^[1]:

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^[1]:

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 extent 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 the following.

“

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 ^1.3 ^1.4 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.

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[pmid15637497-1] 1.0 ^1.1 ^1.2 ^1.3 ^1.4 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.

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