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Echo imaging can correct residual holes in children's open heart surgery
Ventricular septal defect (VSD) is a hole in the wall between two heart chambers, and the pyramidal artery defect is an abnormality in the heart outflow tract - a pathway for delivering blood from the heart to its connected arteries. The resulting abnormal blood circulation can cause various health problems.
The cardiac surgeon repairs some of the pyramidal arterial defects by suturing the patch from the ventricle to one of the effluents, but the residual holes around the patch may allow blood to flow into the right ventricle. Although this complication is rare, it can be life threatening.
“Using cardiac imaging during cardiac surgery can detect the residual hole in the heart that can occur when the surgeon repairs a child's heart defect and provides the opportunity to close the hole during the same procedure.
The use of cardiac imaging during cardiac surgery can detect severe cardiac residual holes that may occur when a surgeon repairs a child's heart defect and provide the surgeon with an opportunity to close the holes during the same procedure. Pediatric cardiologists say that using a tool called transesophageal echocardiography (TEE) during surgery can improve the prognosis of children with congenital heart disease.
Meryl Cohen, a senior author and paediatric cardiologist at the Children's Hospital of Philadelphia (CHOP), said: "We focus on the ventricular septal defect, which is the hole between the two heart chambers." She and the co-author before the Circulation A paper was published that considers these defects to be different from other types of residual holes.
“These defects may present another defect after the initial surgery, which may increase the risk of complications and death in children with heart disease, so using imaging tools to quickly identify these defects can improve our care for these children,” she added. Say.
Jyoti K. Patel, the first author of the study, was a former heart researcher at the CHOP Heart Center and conducted research during her fellowship. The research team published the study in the September 2016 issue of the Journal of Thoracic and Cardiovascular Surgery.
Scientists have reported the use of intraoperative TEE to identify intraventricular septal defects (VSDs). They conducted a retrospective study of 337 children, most of whom were infants who underwent CHOP surgery for the treatment of pyramidal arterial defects between 2006 and 2013.
The current study is the first to evaluate the accuracy of TSE recognition in the wall. The team compared intraoperative TEE during surgery with transthoracic echocardiography (TTE), another imaging tool performed after surgery.
Of the 337 surgical patients, 34 had intramural VSD. Of the 34, both TTE and TEE identified 19 VSDs, while 15 were identified only by TTE. This data shows that TEE has moderate sensitivity (56%) but is highly specific (100%) in identifying intra-wall VSD. The authors noted that "moderate sensitivity indicates that many intramural defects have not been detected in the operating room." However, they added that intraoperative TEE can identify most of the intramural defects that require reintervention (eg, further surgery).
"We hope that this study will increase clinicians' awareness of these intramural defects as an important and unique entity associated with surgical complications," Patel said. “If awareness raising can improve the use of TEE in the operating room, surgeons can better develop strategies that can help prevent these lesions, as well as modify the procedure before the patient leaves the operating room, if there is a wall VSD.”