YF Cheung, TC Yung, MP Leung, KT Chau

Purpose To evaluate the role of transesophageal echocardiography (TEE) in the monitoring of postoperative residual haemodynamics in children with heart diseases.

Patients and Methods Between March to August 1995, 19 studies performed in 16 post-operative patients in the intensive care were reviewed. Their age and weight were of mean 3.9 ± 3.9 years and 11.7 ± 6.8kg, respectively. The indication for echocardiography was suspected unfavourable residual haemodynamic disturbances after definitive corrective surgery. Transthoracic approach was performed prior to TEE and the findings were compared. The children requiring assessment include 6 of tetralogy of Fallot with or without pulmonary atresia, 4 of atrioventricular septal defect, 2 with a Fontan-circuit, 1 each of double outlet right ventricle, total anomalous pulmonary venous drainage, mitral valvar leakage and an obliterated right pulmonary artery due to a slipped band for initial palliation of a ventricular septal defect.

Results Transesophageal echocardiography detected S patients with a regurgitant repaired "mitral" valve and 1 of regurgitant tricuspid valve, 2 with residual inter-atrial shunt in the setting of a Fontan circuit, 2 with impaired left ventricular function, 1 each of residual ventricular septal defect, narrowing across the repaired pulmonary outflow and an intra-atrial blood clot. These informations guided decisions on immediate reoperation (3), the use of inotropes with or without vasodilators (3), weaning of ventilator (4) and early catheterization for residual sequale (1) in 68% of our patients. Transthoracic approach has limited acoustic window in most children (11) and could not be performed in 2 patients. Satisfactory haemodynamic assessment was possible in only 31%.

Conclusion TEE was valuable in assessing residual haemodynamic disturbances in children immediately after cardiac surgery and effectively guided their management.