Objective- To assess impact of peri- operative transoesophageal echocardiography (TOE) on surgery for congenital heart disease in patients weighing less than 10 kilograms.

Methods- Retrospective analysis of patient records over an 18 month period.

Results- 77 patients weighing less than 10 Kg, (Median 5.95, range 3.2-9.97 Kg) aged between 3 & 826 days (Mean age 251 days) had peri-operative TOE using standard multiplane paediatric TOE probes. The procedures included patch closure of VSD (20), repair of tetralogy of Fallot (TOF) (13), repair of complete atrio-ventricular septal defect (cAVSD) (10), arterial switch operation (ASO) (9) and Pulmonary Artery banding (4). Cardiopulmonary bypass was reinstituted in 5 (6.4%) cases based on the initial postoperative TOE findings. These included 2 ASO’s and one patient each with sub-aortic stenosis, repair of cAVSD with tetralogy of Fallot and repair of cAVSD. Other postoperative TOE findings included a small residual VSD in 2 cases, mild branch pulmonary artery stenosis in one patient after ASO and mild left AV valve regurgitation in one patient after cAVSD repair. All of these were corroborated on subsequent trans-thoracic echocardiography (TTE). 2 patients had mild residual lesions on TTE, not detected on the postoperative TOE. There were no complications resulting from peri-operative TOE during any of the surgical procedures.
Conclusion- Even in small infants, peri-operative TOE can safely be performed with modern equipment and is safe and effective in providing intra-operative surgical guidance.