Konjenital kalp hastalıklarının cerrahi tedavisinde intraoperatif transözofageal ekokardiyografinin önemi

Amaç: İntraoperatif transözafageal ekokardiyografi nin (TEE) konjenital kalp hastalıklarının cerrahi tedavisindeki yararı giderek anlaşılmıştır. TEE transtorasik preoperatif tanının kanıtlanmasında, residüel defekt ve tamirden sonra bypasa geri dönme gereksiniminin belirlenmesinde önemli rol oynamaktadır. 3 yıllık bir sürede intraoperatif TEE yaptığımız 67 hastadaki ilk deneyimlerimizi bildirmek istedik. Hastalar ve Yöntem: Hastalarımızın ortalama yaşları 6.8 ± 5.2 yıl idi.Tüm hastalara biplane pediatrik prob kullanıldı. Doğuştan Kalp hastalığı nedeniyle ameliyat olan tüm çocuklara bypass öncesi ve sonrasında TEE yapıldı ve tüm kardiyak defektler görüntülenebildi. Sonuçlar: Altmışyedi hastanın 61’inde ( %91.04) transtorasik ekokardiyografi k tanının tam doğru olduğu kanıtlandı, 4 hastada minor ek farklılık ( %6.3 ), 2 hastada ise önemli ek farklılık saptandı (%2.98). Bu TEE sonuçları ile 2 hastamızda planlanan cerrahi tedavide değişiklik yapıldı. Bypass bitiminde tekrarlanan TEE ile hastaların rezidüel defektleri, ventrikül fonksiyonları ve ön yükleri değerlendirildi. Bypass sonrası TEE ile 47 hastada (%70.14) residüel defekt olmadığı, 17 hastada minimal rezidüel defekt kaldığı görüldü ( % 25.37). İki olguda orta ciddiyette rezidüel defekt saptandı. Bu seride kompleks konjenital kardiyak anomalili bir bebek erken postoperatif dönemde kaybedildi. Olguların %17.91’inde medikal tedavide değişiklik önerildi. Altmışyedi hastanın hiçbirinde TEE çalışması ile ilgili komplikasyon olmadı. Tartışma: Konjenital kalp hastalıklarının tamiri sırasında intraoperatif TEE yapılması hastaların tedavisinde önemli avantajlar sağlamaktadır. Sonuçlarımız kalp cerrahisi sırasında intraoperatif TEE’nin cerrahi girişim gereksinimi veya intraoperatif medikal tedavinin yönlendirilmesi gibi sorunların acil saptanmasında çok yararlı olduğunu göstermiştir.

Intraoperative transesophageal echocardiography during surgery for congenital heart defects

Aim: Intraoperative transesophageal echocardiography ( TEE) has been increasingly utilized during repair of congenital cardiac defects. TEE plays a major role in confi rmation of the preoperative diagnosis, residual defects, and the need to return the bypass after repair. We want to report our initial experience with intraoperative TEE in 67 patients over a 3-year period. Patients and Methots: Patients mean age was 6.8 ± 5.2 years. A pediatric biplane transesophageal probe was used in all patients. TEE was performed both prebypass and postbypass periods. Results: The preoperative diagnosis was correctly confi rmed by TEE in 61 of 67 cases (91.04 %) with minor variances in 4 cases ( 6.3%) and two major variances (2.98 %). Surgical management decisions changed as a result of TEE fi ndings in this two patients. We assessed residual lesions, ventricular function and preload with TEE after postbypass. Postoperative TEE fi ndings showed no residual defect in 47 ( 70.14 %), trivial or mild residual defects in 17 patients ( 25.37 %). There were moderate severe residuel defects in 2 cases ( 2.98%). Complex cardiac congenital defect with one patient was died in the early postperative period. Medical alterations of management were required in 17.91% of cases as a result of postbypass TEE fi ndings. There were no complications in any of the 67 subjects due to TEE study. Conclusions: The intraoperative TEE off ers signifi cant advantages in the management patients undergoing repair of congenital heart disease. Our results confi rm the potential benefi ts of intraoperative TEE during heart surgery to identify problems that need immediate surgical intervention and to assist intraoperative medical management.

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