Patching things up: New cardiac tool helps repair holes in children’s hearts

It’s always important to check your work. A new cardiac imaging tool allows surgeons to repair serious residual holes in the heart that may occur when repairing a child’s heart defect.

The transesophageal echocardiography (TEE) allows surgeons to identify intramural ventricular skeptical defects—or holes in the wall between two heart chambers.

"These defects, which can occur after initial surgery for another defect, can increase the risk of complications and mortality in children with heart disease, so using imaging tools to quickly identify these defects can improve our care of these children," said Meryl S. Cohen, MD, senior author and pediatric cardiologist at Children's Hospital of Philadelphia.

The study team published the research in the September 2016 issue of the Journal of Thoracic and Cardiovascular Surgery.

Researchers performed a retrospective study of 337 children—mostly infants—whounderwent surgery at Children’s Hospital of Philadelphia for conotruncal defects from 2006 to 2013. The study looked at the effects of TEE compared to transthoracic echocardiography (TTE), which is performed after surgery.

Of the 337 surgical patients, 34 had intramural ventricular skeptical defects (VSD). Of those 34, both TTE and TEE identified 19 VSDs, while 15 were identified by TTE only. That data showed that TEE had a 56 percent sensitivity, but a 100 percent specificity in identifying intramural VSDs.

In the study the authors note that, "the modest sensitivity suggests that many intramural defects are not detected in the operating room." However, they add, intraoperative TEE was able to identify most of the intramural defects requiring further surgery.

"We hope that this research will increase clinicians' awareness of these intramural defects as an important distinct entity related to surgical complications," Dr. Jyoti K. Patel, a former cardiac fellow in the Cardiac Center at the Children’s Hospital of Philadelphia, said. "If a greater awareness enhances the use of TEE in the operating room, surgeons may better develop strategies to both help prevent these lesions and to consider revising their operations before the patient leaves the operating room if an intramural VSD exists."