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KMID : 0367420040470121281
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Journal of Korean Pediatric Society
2004 Volume.47 No. 12 p.1281 ~ p.1286
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Usefulness of Intraoperative Transesophageal Echocardiography.
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Lee Dong-Won
Kim Byung-Mok
Kim Se-Young
Kim Yeo-Hyang
Hyun Myung-Chul
Lee Sang-Bum
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Abstract
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Purpose : This study was undertaken to learn the usefulness, cost-effectiveness and safety of intraoperative transesophageal echocardiography(ITEE) during open heart surgery for congenital heart diseases.
Methods : The usefulness and safety of ITEE were assessed in 254 patients who underwent open heart surgery for congenital heart diseases from January 1, 2001 to June 30, 2003, with retrospective chart reviews and a simple relative cost analysis.
Results : Among 254 open heart surgery patients, ITEE was not performed in 47 cases. The majority of cases were atrial septal defect(15 cases, 32%), ventricular septal defect(16 cases, 34%), ASD and VSD(three cases, 6.4%). In the other five smaller babies(weight range 2.7-3.1 kg), the ITEE probes couldn’t pass the patient’s esophagus. In 207 cases, ITEE were performed without any major complications. Residual abnormalities were identified by ITEE in six cases(2.9%), requiring surgical revisions : four cases with right ventricular outflow tract pressure gradient, one case of residual mitral regurgitation and one case of residual aortic stenosis and supravalvular pulmonary stenosis. If these six cases had not directly returned to bypass for surgical revision of the initial repair at the same operation, the additional fee of reoperation after leaving operation room were estimated to be ￦47,496,346(￦7,916.057 per patient). In contrast, the costs of performing ITEE in all open heart surgical patients(207 patients) stood to total ￦82,800,000(￦400,000 per patient).
Conclusion : ITEE was not considered to be a beneficial diagnostic modality in terms of cost effectiveness in this study. But, the routine use of ITEE during most open heart surgery for congenial heart defects may be warranted as it produces no major complication, improves postoperative care, and comforts surgeon’s feelings. (Korean J Pediatr 2004;47:1281-1286)
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KEYWORD
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Transesophageal echocardiography, Congenital heart disease
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