Assessment of ventricular septal defect closure by intraoperative epicardial ultrasound

Intraoperative epicardial two-dimensional echocardiographic imaging, color flow mapping and contrast echocardiography were used in 31 patients after patch closure of a ventricular septal defect to determine their respective values in the assessment of residual shunting after cardiopulmonary bypass a...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 1990-12, Vol.16 (7), p.1672-1679
Main Authors: Stümper, Oliver, Fraser, Alan G., Elzenga, Nynke, Van Daele, Marc, Frohn-Mulder, Ingrid, Van Herwerden, Lex A., Quaegebeur, Jan M., Sutherland, George R.
Format: Article
Language:English
Subjects:
Biological and medical sciences
Cardiology. Vascular system
Cardiopulmonary Bypass
Child, Preschool
Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava
Echocardiography
Heart
Heart Septal Defects, Ventricular - diagnostic imaging
Heart Septal Defects, Ventricular - epidemiology
Heart Septal Defects, Ventricular - surgery
Humans
Medical sciences
Monitoring, Intraoperative - methods
Postoperative Complications - epidemiology
Predictive Value of Tests
Reoperation
Risk Factors
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Summary:Intraoperative epicardial two-dimensional echocardiographic imaging, color flow mapping and contrast echocardiography were used in 31 patients after patch closure of a ventricular septal defect to determine their respective values in the assessment of residual shunting after cardiopulmonary bypass and for the prediction of long-term results. Epicardial imaging showed no incidence of patch dehiscence. Residual shunting detected by color flow mapping or contrast echocardiography was graded into one of four categories (0 to III). Real time analysis of color flow mapping studies suggested no shunting (grade 0) in 2 patients, grade I shunting in 20, grade II in 8 and grade III in 1; contrast studies suggested grade 0 in 15, grade I in 6, grade II in 8 and grade III in 2. Interobserver variation in real time encoding of grade I or II shunting was 25% by color flow mapping and 6% by contrast echocardiography. Subsequent frame by frame analysis revealed that both diastolic and early systolic right ventricular turbulence gave rise to false positive results during real time analysis of color flow mapping studies. Color flow mapping allowed exact localization of residual shunting, whereas contrast echocardiography allowed better semiquantification. Postbypass results were correlated in 30 patients with late postoperative precordial studies (mean interval 7.5 months). Persistent shunts were found in 6 (20%) of 30 patients. No patient required reoperation for residual shunting. The predictive value of immediate grade I or II shunting as a marker for persistent long-term shunting was poor, whereas both patients with immediate grade III shunting had shunt persistence, indicating that immediate revision should be considered in such patients. Intraoperative epicardial ultrasound is valuable for the immediate exclusion of important residual shunting after ventricular septal defect closure. Maximal information is obtained when color flow mapping and contrast echocardiography are used in combination.
ISSN:0735-1097
1558-3597
DOI:10.1016/0735-1097(90)90318-J