The role of intraoperative epicardial echocardiography in pediatric cardiac surgery

Aim Our aim was to evaluate the findings and the role of intraoperative epicardial echocardiography ( IEE ) in the management of pediatric cardiac surgery patients. Methods Patients evaluated with IEE between December 2015 and December 2017 were analyzed retrospectively. Demographic data, preoperative transthoracic echocardiography ( TTE ), and IEE reports were evaluated. Results A total of 410 patients evaluated by IEE were included in the study. Of these, 52% were women, and 48% were men. The median age was 8.5 months (range: 1 month–7 years), and median body weight was 7.1 kg (range: 3.3–61 kg). The most common diagnoses were tetralogy of Fallot ( TOF ; n = 148), ventricular septal defect ( VSD ; n = 117), atrial septal defect ( ASD ; n = 57), and complete atrioventricular septal defect ( AVSD ; n = 48). There were minor residual lesions not requiring reestablishment of cardiopulmonary bypass ( CPB ) in 16.6% (n = 68), while major residual lesions requiring return to CPB were determined in 5.1% (n = 21). Major residual lesions were detected in 7 patients with TOF (4 severe right ventricular outflow tract obstructions, 2 pulmonary artery stenosis, 1 residual VSD shunt), 6 patients with VSD (hemodynamically significant residual shunts), and 5 patients with complete AVSD (3 left atrioventricular valve regurgitations, 1 right atrioventricular valve regurgitation, 1 left ventricular outflow tract obstruction). Transient bradycardia was observed in 5 patients. Conclusion Intraoperative epicardial echocardiography provides good guidance during congenital heart surgery. IEE helps to clarify the surgical planning and decreases morbidity and mortality due to unnecessary invasive procedures, especially for pathologies involving the pulmonary artery and its branches, as well as for apical ventricular septal defects.