Additive value of intraoperative hemodynamic monitoring to epicardial echocardiography during surgical repair of children with congenital heart disease

Abstract

Aim The aim was to evaluate the additive value of intraoperative hemodynamic monitoring to epicardial echocardiography on the surgical outcome in children undergoing surgical correction of congenial heart disease. Patients and methods This study was conducted on 238 children with congenital heart disease who were enrolled for surgical correction. They were arranged in two groups: group A included 159 children in whom e-echo was used to detect intraoperative residual lesions while group B included 79 patients in whom e-echo and intraoperative hemodynamic monitoring using oxygen saturation step-up and intracardiac pressures after disconnection of cardiopulmonary bypass to detect residual shunt flow and outflow tract obstruction were used; revision of bypass was done when significant lesions were detected for repair. The follow-up echocardiography showed no significant residual lesions and complications in the subgroup of patients who had both epicardial monitoring and hemodynamic studies, in contrast to other groups of patients in whom19 patients had residual lesions and complications. Conclusions Routine use of intraoperative epicardial echocardiography allows detection of majority of residual defects after bypass; however, addition of other intraoperative monitoring tools like hemodynamic pressure measurement and oxygen saturation step-up can result in the detection of more residual lesions with revision of bypass, thus saving these patients from reoperation and postoperative complications.

Keywords

• icu intensive care unit
• pa pulmonary artery
• pg pressure gradient
• ps pulmonary stenosis
• ra right atrium
• tga transpostion of great vessels
• vsd ventricular septal defect