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KMID : 0367219920090010085
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Sejong Medical Journal
1992 Volume.9 No. 1 p.85 ~ p.92
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Two-stage Arterial Switch for Transposition of the Great Arteries and Intact Ventricular Septum
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김성호
이흥재/고재곤/최종운/김덕하/박표원/이영탁/서동만/김남수
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Abstract
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Transesophageal echocardiography (TEE) has opened a new window to the heart1) and great vessels. The unique vantage point from the esophagus provides views of specific cardiac structures and lesions that are not easily and clearly represented by
transthoracic echocardiogrphy (TTE).
We analyzed the documented 529 consecutive TEE examinations in ambulatory and admitted adult patients in our clinic. These studies were performed between October 1989 and April 1992. Esophageal insertion of probe was not achieved in 3 patients
(0.6%)
due to severe gagging and a lack of patient cooperation. No complications were encountered in contrast to other reports2.3.4. The necessity and techniques5) of TEE have been described previously. The consented and informed patients must fast at
least 6
hours before the study. Patients received no preoperative medications, e.g. no topical anesthetic, no drying agent and no sedative. Antibiotic prophylaxis for endocarditis is not used4.6.7.8. We used only lubricating jelly on the tip of the probe
According to anatomical foci of diagnostic interest the 529 studies are classified in 5 patient group(PG) as follows (Table 1).
PG 1 : atrium and auricle 12.5%(66/529)
PG 2 : semilunar valves, atrioventricular valves with their substructures 69.35%(367/529).
PG 3 : aorta and coronary artery 8.6% (46/529).
PG 4 : ventricle 2.8% (15/529).
PG 5 : congenital heart disease 7.3% (39/529)
The 11 patients with subacute bacteral endocarditis (SBE) are included in PG 2 with valve Chronologically classifying (Table 2). The 436 studies (82.4%) are performed in preoperative diagnostic period, 38 examinations (7.2%) during the cardiac
surgery
in operating room and 55 cases (10.4%) in the postoperative follow-up period.
This postoperative patient group includes 46 patients with at least one prosthetic valve replacement.
Our principal reason for performing TEE is it provides unique information that is very difficult tobtain with any other approach, e.g. in cases of COPD. Congenital heart disease with abnormal anatomical situation. TEE also provided more
anatomical
detailes of various conditions such as pulmonic valve endocarditis9) in patients with tetralogy of Fallot (Case 1, Fig. 1,2,3,4,), nonpenetrating chest trauma10) (Case 3. Fig. 9-12) and valvular heart disease with suspision of left atrial
thrombus,
especially when a percutaneous transseptal mitral valvuloplasy is planed. We find TEE very useful for the confirmation of angiographycally diagnosed ostial stenosis of the left coronary artery (Vase 2, Fig. 5.6). TEE is moreover useful during the
patch
widening operation of ostial lesion (Fig. 7). It is also very conveniant for the postoperative follow-up evaluation of such cases (Fig. 8).
We concluded that TEE is feasible in most adult patients with heart and great vessel disease. It has a very low complication rate3.4.8), if the patients with contraindications11) are excluded from the examination. On groupds of our experience it
is
generally recommendable to perform the TEE examination without topical anesthetic, drying agent or sedative. Antibiotic endocarditis prophylaxis for the high risk patients with prosthetic heart valves12) is still object of discussion4.6.8, though
today's tendency is disregard of this therapeutic principle and our experience speaks well for this trends.
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KEYWORD
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