Objective: Transesophageal echocardiography (TEE) in the immediate postoperative period is standard of care for most congenital heart operations. However, patient size, esophageal anatomy, or surgical field interference may prevent its use. We hypothesize that epicardial echocardiography (EPI) is a safe and accurate alternative.

Methods: 98 consecutive neonates underwent EPI(group OR EPI). Discrepancies between these EPIs and the first complete post-operative transthoracic echocardiogram (TTE)were compared. A second group of 22 consecutive and contemporaneous neonates(group OR TEE) underwent intraoperative TEE, not EPI. Discrepancies between those TEEs and the first complete post-operative TTE were also compared.

Results: EPI views were obtained in all patients without hemodynamic compromise. Group OR EPI had lower weight (median 2.9, range 1-4.2kg) vs. OR TEE patients (3.6, 3.2-4.5 kg),(p < 0.0001), but similar age at surgery (OR EPI median 5, range 1-29 days, OR TEE 5, 1-28 days, p = 0.5). There was no difference between the frequency of minor discrepancies with TTE in group OR EPI (24%) vs. group OR TEE (32%) (p =0.36), as shown in the Table. One patient required TEE after EPI to diagnose tricuspid stenosis related to a ventricular septal hematoma. No minor discrepancies required further intervention. EPI was diagnostic in 2 cases of total anomalous pulmonary venous return that required additional surgery.

Conclusions: Intraoperative epicardial echocardiography is a safe and accurate alternative to transesophageal echocardiography in neonates.