الفهرس 
Historical background of intraoperative echocardiographyOnly 14 pages are availabe for public view
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Abstract
Our study was conducted on 25 pediatric patients who were scheduled to undergo cardio-pulmonary bypass at the Pediatric Cardiothoracic Surgery department.
The patients were subjected to full history taking, thorough clinical examination, routine preoperative investigations, ECG, CXR, preoperative TTE and IOTEE.
The aim of the work was to assess the role of IOTEE during open cardiac surgeries in the pediatric age group in our centre.
In this study, the majority of patients had congenital heart defect (88%) while only (12%) had rheumatic valvular disease.
The three most common surgical categories were right ventricular reconstruction and VSD closure in (36%) of patients, mitral valve repair in (24%) of patients and closure of isolated VSDs in (16%) of patients .The first group included 6 patients (24%) with TOF, 2 patients (8%) with DORV (Fallot types) and one patient (4%) with (Pulmonary atresia/VSD/PDA). The second group included 3 patients (12%) with congenital mitral valve prolapse and 3 patients (12%) with rheumatic mitral regurgitation.
IOTEE did not lead to any complication resulting in long-term morbidity or mortality. No complications were encountered in (92%) of patients, while transient minor complications were encountered in (4%) of patients in the form of minor transient GIT bleeding. Complications requiring probe removal occurred in (4%) of patients.
The TEE probe was easily inserted in all patients (100%) at the first attempt.
Prebypass TEE confirmed the preoperative diagnosis and was able to answer all the proposed questions in all patients (100%). It detected minor variances in (24%) of patients, (50%) of these minor variances were related to abnormalities in the interatrial septum and atrial anatomy. It detected valuable new information (major variances) necessitating a change in the surgical plan in (4%) of the studied population.
Repeat CPB based on IOTEE findings was needed in only (12.5%) of the postoperatively assessed patients although (40%) had moderate to severe residual defects reflecting that this frequency was a purely surgeon-dependent decision regardless of the estimated severity of the residual lesion by the echocardiographer.
Postoperative TEE following repair of RVOT showed residual RVOTO in (50%) of patients, which DROPped dramatically when revised by postoperative TTE few days later after the operation.
Following TOF and DORV repair, mild PR occurred in (75%) of patients, while moderate PR occurred in (25%) of patients.
Residual VSDs were encountered in (41.6%) of patients with the most common location occurring at the superior margin of the patch.
Ventricular dysfunction and signs of volume depletion were among the TEE observations that helped in deciding the appropriate need for inotropics and volume replacement.