Aim- To assess the role of peri-operative transoesophageal echocardiography (TOE) during the arterial switch operation.
Methods- Case note review of 22 babies undergoing arterial switch operation between April 2005 & September 2008 (41 months). Correlation of pre and post-operative trans-thoracic echo (TTE) with TOE findings, impact of intra-operative TOE and complications with use of TOE were noted. Standard paediatric multi-plane TOE probes were used.
Results- 20/22 patients had a peri-operative TOE. Median weight was 3.69 Kg (range 3.2-4.3 Kg). Mean age at surgery was 22 days. The preoperative TOE in two patients demonstrated a previously undetected origin of the circumflex from the right coronary artery. Cardiopulmonary bypass was reinstituted based on the initial post-operative study in 2 cases, where RV dyskinesia & significant branch pulmonary stenosis were noted. One of these had a satisfactory RVOT reconstruction which was confirmed on TOE. The second patient continued to have elevated RV pressures after reconstruction of the RVOT although the postoperative TOE did not demonstrate an abnormality. Subsequent scans (TTE and TOE) demonstrated branch PA stenosis which was relieved by further surgery. One patient had mild branch pulmonary artery stenosis noted on TOE and confirmed on subsequent TTE’s. The post-op TOE findings correlated well with subsequent TTE’s in all cases. No problems were encountered in introducing the probe and there were no complications.
Conclusion: Peri-operative TOE can be a valuable and safe tool for the surgeon during the arterial switch. Branch PA stenosis can be detected but not excluded on TOE.