Cardiac Imaging Helps Detect Residual Septal Defects

Using transesophageal echocardiography (TEE) could help surgeons identify intramural ventricular septal defects (VSDs) in real-time, according to a new study.

Researchers at the Children's Hospital of Philadelphia (CHOP; PA, USA) conducted a study to evaluate the ability of TEE to identify intramural VSDs occurring during surgical repair of heart defects in children with congenital heart disease (CHD). To do so, they collected intraoperative TEE and postoperative transthoracic echocardiography (TTE) data in 337 pediatric patients that underwent biventricular repair of conotruncal anomalies between 2006 and 2013. TEE ability to accurately identify residual defects was assessed using postoperative TTE as the reference imaging modality.

The results showed that intramural VSDs occurred in 34 of the patients evaluated; 19 were identified by both TTE and TEE, and 15 were identified by TTE alone. Of the VSDs requiring reintervention, 6 of 7 intramural VSDs and all 5 peripatch VSDs were identified by intraoperative TEE. In addition, TEE guided the intraoperative decision to return to cardiopulmonary bypass in an attempt to close residual defects in 12 patients with intramural VSDs and in 4 patients with peripatch VSDs; 10 of the intramural VSDs and all 4 peripatch VSDs resolved or became smaller on final intraoperative TEE. The study was published in the September 2016 issue of Journal of Thoracic and Cardiovascular Surgery.

“We hope that this research will increase clinicians' awareness of these intramural defects as an important distinct entity related to surgical complications,” said lead author Jyoti Patel, MD, of the department of pediatrics. “If a greater awareness enhances the use of TEE in the operating room, surgeons may better develop strategies to both help prevent these lesions and to consider revising their operations before the patient leaves the operating room if an intramural VSD exists.”

TEE is an alternative method for performing an echocardiogram, using a probe containing an ultrasound transducer at its tip that is passed into the esophagus. Unlike standard echocardiograms, the transducer is close to the upper chambers of the heart, providing very clear images of the heart structures and valves. TEE is often used in people with a thicker chest wall, in the obese, and to provide information during surgery to repair heart valves, a tear in the aorta, or congenital heart lesions.

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