Transesophageal Echocardiography in Infants and Children: Use and Importance in the Cardiac Intensive Care Unit

Recent development of small diameter (7 mm) biplane transesophageal echocardiography (TEE) probes has extended the select application of TEE to neonates, infants, and small children. We reviewed indications and uses for TEE in our neonatal and pediatric cardiac intensive care units over a 2-year period. Sixty-six TEE studies were performed in preoperative and postoperative settings in the intensive care unit after standard transthoracic studies. Age and weight of subjects ranged from 1 day to 16 years (mean 19 months) and 2.5 to 52 kg (mean 8.3 kg), respectively. Eighty-three percent of studies were performed in the immediate postoperative period after correction or palliation of congenital heart disease (including transposition of the great arteries, tetralogy of Fallot, atrioventricular septal defect, right ventricular conduit revision, Glenn shunt, and neonatal orthotopic heart transplantation). TEE advantages included unobstructed echo windows, particularly in postoperative settings of open sternum or high ventilatory support. Biplane imaging and Doppler provided additional hemodynamic information not otherwise detectable by noninvasive means. Posttransplant left and right ventricular function was immediately assessable. Overall findings included: residual shunts 24%, valvar insufficiencies 43%, residual gradients 4%, and left ventricular function or wall motion abnormalities 12%. TEE is a useful noninvasive adjunct in intensive care management of pediatric cardiac patients.