The Role of Transesophageal Echocardiography in Evaluating the Perioperative Tetralogy of Fallot in Pediatric Patients

  • Dr Xiao-jing Ma, Pediatric Heart Center, Children’s Hospital of Fudan University,Shanghai, China
  • Dr Guo-ying Huang, Pediatric Heart Center, Children’s Hospital of Fudan University,Shanghai, China
  • Dr Bing Jia, Pediatric Heart Center, Children’s Hospital of Fudan University,Shanghai, China
  • Dr Zhang-gen Chen, Pediatric Heart Center, Children’s Hospital of Fudan University,Shanghai, China

    • Objective: To elucidate the role of transesophageal echocardiography (TEE) in evaluating tetralogy of Fallot (TOF) during perioperative period in pediatric patients.
    Methods: One hundred and four consecutive cases of TOF aged (2.7±3.4) years old were included. Intraoperative TEE and transthoracic echocardiography (TTE) before and after operation within 1 week were performed.
    Results: (1) All cases were diagnosed as TOF by both TEE and TTE. According to surgical exploration, doubly-committed VSD was verified in 11 cases and subaortic VSD in 93 cases. The diagnostic accordance rate was 99.0% by TEE and 98.1% by TTE. Stenosis was mainly at infundibulum, pulmonary arteries and both sites in 40, 11 and 53 cases, respectively. There’s no significant difference between TEE and TTE in defining the sites of stenosis (98.1% vs. 96.2%). (2) Residual shunt was found in 32 cases (30.8%) by TEE. Instant intervention was performed in only 1 patient with shunt of 4 mm. Residual obstruction was found in 18 cases (17.3%) by TEE. Instant intervention was performed in 3 patients with pressure gradient over 36 mmHg. However, the obstruction of distant pulmonary arteries was not seen by TEE in 4 patients (3.8%), but detected by TTE at followup. Pulmonary regurgitation was found in 70 cases (67.3%) by TEE. Conclusions: TEE was reliable to diagnose TOF before operation and detect residual problems after surgical repair, except for the residual obstruction of distant pulmonary arteries.

    Keywords: transesophageal echocardiography (TEE); tetralogy of Fallot (TOF)