Usefulness of intraoperative transesophageal echocardiography in the assessment of surgical repair of pediatric ventricular septal defects with video-assisted endoscopic techniques in children

Background: Mini cardiac operative procedures with video-assisted endoscopic techniques for closure of ventricular septal defects (VSDs) in pediatric patients have become quite popular for cardiac surgery. A precise diagnosis is very important for determining the surgical approach, and evaluation by intraoperative transesophageal echocardiography (TEE) plays a major role in confirmation of the preoperative diagnosis, residual defects, and the need to return to the bypass after repair. Methods: Sixty-five patients (30 boys and 35 girls; aged 8.7±5.3 years) who were undergoing minimally invasive closure of VSDs were monitored with a Hewlett-Packard color Doppler pediatric TEE throughout the procedure. Results: Closure of the defect was successfully performed in all patients. Sixty-two patients showed neither residual shunt nor aortic regurgitation after the repair. Residual leaks were detected intraoperatively in 3 patients after the repair. One patient required a return to the bypass with an immediate reoperation due to a residual color jet diameter of >3 mm. One patient was changed from video-assisted endoscopic techniques to a surgical approach for closure of the VSD from a conventional median sternotomy after identification by TEE of an outlet-type perimembranous VSD with 2 additional muscular VSDs. Conclusions: Our study showed that, with refinement of surgical closure of VSD via video-assisted endoscopic techniques, intraoperative TEE provides valuable and accurate information for decision-making in surgical management, provides immediate assessment of surgical repairs, and prevents reintervention and the morbidity associated with residual flow.