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Pediatric Cardiology

, Volume 39, Issue 5, pp 884–891 | Cite as

Intraoperative Completion Angiogram May Be Superior to Transesophageal Echocardiogram for Detection of Pulmonary Artery Residual Lesions in Congenital Heart Surgery

  • Luke Lamers
  • Erick E. Jimenez
  • Catherine Allen
  • Derreck Hoyme
  • Entela Bua Lushaj
  • Petros V. Anagnostopoulos
Original Article
  • 150 Downloads

Abstract

The purpose of this study was to assess the diagnostic capabilities of transesophageal echocardiography (TEE) compared to completion angiography for detection of residual post-operative pulmonary artery lesions. This is a retrospective review of 19 consecutive surgical cases involving the pulmonary arteries that had post-operative TEE and completion angiography from 2014 to 2017. The echocardiograms were reviewed by 2 blinded examiners and categorized as adequate or inadequate visualization of the surgical repair. Based on TEE images, the surgical repair was graded as no revision necessary, residual lesion present requiring revision, or unable to assess. TEE was compared to completion angiography to determine the ability of each method to detect residual pulmonary artery lesions. Fifty-three percent of TEE imaging was graded as inadequate. Based on TEE, surgical revision was indicated in 2 of 19 cases. Completion angiography documented 4 additional residual lesions resulting in surgical revision in 6 of 19 patients. TEE sensitivity for detecting residual pulmonary artery lesions was 40%. One Glenn patient with adequate image quality and repair by TEE had moderate left pulmonary artery stenosis by completion angiography. All other discrepancies occurred in patients with inadequate TEE imaging. No patient with pulmonary artery abnormalities had hemodynamic instability or excessive desaturations. Completion angiography-related complications included three transient arrhythmias with no increased incidence of acute kidney injury. Completion angiography may be more effective than TEE at detecting post-operative pulmonary artery lesions even in patients not manifesting clinical symptoms. Documentation of residual lesions with completion angiography allows immediate surgical revision potentially limiting necessity for future interventions.

Keywords

Completion angiography Post-operative pulmonary artery lesions Transesophageal echocardiography 

Abbreviations

AKI

Acute kidney injury

CA

Completion angiography

CHD

Congenital heart disease

CPB

Cardiopulmonary bypass

MPA

Main pulmonary artery

NPV

Negative predictive value

PA

Pulmonary artery

PDA

Patent ductus arteriosus

PPV

Positive predictive value

SCr

Serum creatinine

SVC

Superior vena cava

SVT

Supraventricular tachycardia

TEE

Transesophageal echocardiography

Notes

Compliance with Ethical Standards

Conflict of interest

Luke Lamers, Erick E. Jimenez, Catherine Allen, Derreck Hoyme, Entela Bua Lushaj, and Petros V. Anagnostopoulos declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

Following Institutional Review Board approval, this study was completed as a retrospective chart review with waiver of informed consent.

References

  1. 1.
    Gilboa SM, Devine OJ, Kucik JE et al (2016) Congenital heart defects in the United States: estimating the magnitude of the affected population in 2010. Circulation 134(2):101–109CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Pillutla P, Shetty KD, Foster E (2009) Mortality associated with adult congenital heart disease: trends in the US population from 1979 to 2005. Am Heart J 158(5):874–879CrossRefPubMedGoogle Scholar
  3. 3.
    Jacobs JP, Mavroudis C, Quintessenza JA et al (2014) Reoperations for pediatric and congenital heart disease: an analysis of the Society of Thoracic Surgeons (STS) congenital heart surgery database. Semin Thorac Cardiovasc Surg 17(1):2–8CrossRefGoogle Scholar
  4. 4.
    Mazwi ML, Brown DW, Marshall AC et al (2013) Unplanned reinterventions are associated with postoperative mortality in neonates with critical congenital heart disease. J Thorac Cardiovasc Surg 145(3):671–677CrossRefPubMedGoogle Scholar
  5. 5.
    Svensson B, Idvall E, Nilsson F et al (2016) Health-related quality of life in children with surgery for CHD: a study from the Swedish National Registry for Congenital Heart Disease. Cardiol Young 25(3):1–11Google Scholar
  6. 6.
    Randolph GR, Hagler DJ, Connolly HM et al (2002) Intraoperative transesophageal echocardiography during surgery for congenital heart defects. J Thorac Cardiovasc Surg 124(6):1176–1182CrossRefPubMedGoogle Scholar
  7. 7.
    Rosenfeld HM, Gentles TL, Wernovsky G et al (1998) Utility of intraoperative transesophageal echocardiography in the assessment of residual cardiac defects. Pediatr Cardiol 19(4):346–351CrossRefPubMedGoogle Scholar
  8. 8.
    Ayres NA, Miller-Hance W, Fyfe DA et al (2005) AMERICAN SOCIETY OF ECHOCARDIOGRAPHY REPORT Indications and Guidelines for Performance of Transesophageal Echocardiography in the Patient with Pediatric Acquired or Congenital Heart Disease. J Am Soc Echocardiogr 18:91 – 8CrossRefPubMedGoogle Scholar
  9. 9.
    Holzer RJ, Sisk M, Chisolm JL et al (2009) Completion angiography after cardiac surgery for congenital heart disease: complementing the intraoperative imaging modalities. Pediatr Cardiol 30(8):1075–1082CrossRefPubMedGoogle Scholar
  10. 10.
    Shuhaiber JH, Bergersen L, Pigula F et al (2010) Intraoperative assessment after pediatric cardiac surgical repair: initial experience with C-arm angiography. J Thorac Cardiovasc Surg 140:e1-3CrossRefPubMedGoogle Scholar
  11. 11.
    Asoh K, Hickey E, Dorostkar PC et al (2009) Outcomes of emergent cardiac catheterization following pediatric cardiac surgery. Catheter Cardiovasc Interv 73(7):933–940CrossRefPubMedGoogle Scholar
  12. 12.
    Garg R, Murthy K, Rao S, Muralidhar K (2009) Intra-operative trans-esophageal echocardiography in congenital heart disease. Ann Card Anaesth 12(2):173CrossRefGoogle Scholar
  13. 13.
    Motta P, Miller-Hance WC (2012) Transesophageal echocardiography in tetralogy of fallot. Semin Cardiothorac Vasc Anesth 16(2):70–87CrossRefPubMedGoogle Scholar
  14. 14.
    Madriago EJ, Punn R, Geeter N, Silverman NH (2016) Routine intra-operative trans-oesophageal echocardiography yields better outcomes in surgical repair of CHD. Cardiol Young 26(2):263–268CrossRefPubMedGoogle Scholar
  15. 15.
    Dragulescu A, Golding F, Van Arsdell G et al (2012) The impact of additional epicardial imaging to transesophageal echocardiography on intraoperative detection of residual lesions in congenital heart surgery. J Thorac Cardiovasc Surg 143(2):361–367.e1CrossRefPubMedGoogle Scholar
  16. 16.
    Lamers L, Moran M, Torgeson J, Hokanson J (2016) Radiation reduction capabilities of a next-generation pediatric imaging platform. Pediatr Cardiol 37(1):24–29CrossRefPubMedGoogle Scholar
  17. 17.
    Partridge J, McGahan G, Causton S et al (2006) Radiation dose reduction without compromise of image quality in cardiac angiography and intervention with the use of a flat panel detector without an antiscatter grid. Heart 92:507–510CrossRefPubMedGoogle Scholar
  18. 18.
    Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P (2004) Acute Dialysis Quality Initiative workgroup the A. Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8(4):R204–R212CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Li S, Krawczeski CD, Zappitelli M et al (2011) Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study. Crit Care Med 39:1493–1499CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Tew S, Fontes ML, Greene NH, Kertai MD, Ofori-Amanfo G, Jaquiss RDB et al (2017) Natural history of nonimmune-mediated thrombocytopenia and acute kidney injury in pediatric open-heart surgery. Pediatr Anesth 27(3):305–313CrossRefGoogle Scholar
  21. 21.
    Pedersen KR, Povlsen JV, Christensen S, Pedersen J, Hjortholm K, Larsen SH et al (2007) Risk factors for acute renal failure requiring dialysis after surgery for congenital heart disease in children. Acta Anaesthesiol Scand 51(10):1344–1349CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Cardiology, Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  2. 2.Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  3. 3.Division of Cardiothoracic Surgery, Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA

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