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Intraoperative and Postoperative Transesophageal Echocardiography in Congenital Heart Disease

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Transesophageal Echocardiography for Congenital Heart Disease

Abstract

The early experience with epicardial imaging in patients undergoing surgery for congenital heart disease (CHD) provided strong evidence to the idea that intraoperative echocardiography could guide specific surgical and anesthetic adjustments during this critical period. Since the introduction of transesophageal echocardiography (TEE) to the intraoperative setting in the late 1980s, numerous publications have documented the utility of this imaging modality in the care of patients with CHD. Technologic advances over the years that have included miniaturization of probes and multiplane imaging now allows for comprehensive assessment of structural abnormalities, evaluation of hemodynamics, and very importantly, appraisal of the surgical results in nearly all patients with CHD. The recognition of residual pathology of hemodynamic significance during congenital surgery and the ability of TEE to guide the surgical revision as necessary, represent major contributions to perioperative care. Additional important benefits of this technology in the perioperative period include its role as a monitoring adjunct to facilitate hemodynamic and pharmacologic management and to influence treatment strategies. TEE also provides a framework to assist in the formulation of management plans in the immediate postoperative period and the further characterization of postoperative unexpected/unusual findings or problems.

This chapter provides an overview of the applications of TEE in the intraoperative care of patients with CHD with an emphasis on impact on surgical, medical, and anesthetic management. Data on cost effectiveness, pitfalls, and limitations of intraoperative TEE are reviewed. Lastly, the role of TEE in the postoperative setting in the patient with CHD is addressed.

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Authors and Affiliations

  1. Divisions of Pediatric Anesthesiology and Pediatric Cardiology, Departments of Pediatrics and Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, 6621 Fannin, Suite W17417, Houston, TX, 77030, USA

    Wanda C. Miller-Hance MD, FACC, FASE

  2. Department of Cardiovascular Anesthesiology, Kaiser Permanente, 2425 Geary Blvd, San Francisco, CA, 94115, USA

    Isobel A. Russell MD, PhD, FACC

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  1. Wanda C. Miller-Hance MD, FACC, FASE
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  2. Isobel A. Russell MD, PhD, FACC
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Correspondence to Wanda C. Miller-Hance MD, FACC, FASE .

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Editors and Affiliations

  1. Childrens Hospital Los Angeles Department of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, California, USA

    Pierre C. Wong

  2. Pediatric Cardiovascular Anesthesiology, Texas Children's Hospital, Houston, USA

    Wanda C. Miller-Hance

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Miller-Hance, W.C., Russell, I.A. (2014). Intraoperative and Postoperative Transesophageal Echocardiography in Congenital Heart Disease. In: Wong, P., Miller-Hance, W. (eds) Transesophageal Echocardiography for Congenital Heart Disease. Springer, London. https://doi.org/10.1007/978-1-84800-064-3_15

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