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Usefulness of Intraoperative Transesophageal Echocardiography

Korean Journal of Pediatrics 2004;47(12):1281-1286.
Published online December 15, 2004.
Usefulness of Intraoperative Transesophageal Echocardiography
Dong Won Lee1, Byung Mok Kim1, Sei Young Kim2, Yeo Hyang Kim3, Myung Chul Hyun1, Sang Bum Lee1
1Department of Pediatrics, Collage of Medicine, Kyungbook National University, Daegu, Korea
2Department of Pediatrics, Collage of Medicine, Daegu Catholic University, Daegu, Korea
3Department of Pediatrics, Daegu Fatima Hospital, Daegu, Korea
수술 중 경식도 심초음파 검사의 유용성
이동원1, 김병목1, 김세영2, 김여향3, 현명철1, 이상범1
1경북대학교 의과대학 소아과학교실
2대구가톨릭대학교 의과대학 소아과학교실
3대구가톨릭대학교 대구파티마병원 소아과
Correspondence: 
Sei Young Kim, Email: ksy8879@cu.ac.kr
Abstract
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.
Key Words: Transesophageal echocardiography, Congenital heart disease


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