Ventricular septal defects (VSDs) are holes in the wall between
two heart chambers, while conotruncal defects are abnormalities in the
heart's outflow tracts - the pathways that carry blood from the heart to
its connected arteries. The resulting abnormal blood circulation may
lead to a variety of health problems.
Cardiac surgeons repair some conotruncal defects by sewing a patch
from the ventricle to one of the outflows, but a residual hole around
the patch may allow blood to flow into the right ventricle. Although
this complication is rare, it is potentially life-threatening.
‘Using cardiac imaging during heart surgery can detect residual holes in the heart that may occur when surgeons repair a child's heart defect, and offers an opportunity to close those holes during the same operation.’
Using cardiac imaging during heart surgery can detect serious
residual holes in the heart that may occur when surgeons repair a
child's heart defect, and offers surgeons the opportunity to close those
holes during the same operation. Pediatric cardiology experts say using
this tool, called transesophageal echocardiography (TEE), during
surgery may improve outcomes for children with congenital heart disease.
"We focused on intramural ventricular septal defects, which are
holes between two chambers of the heart," said Meryl S. Cohen, senior author and pediatric cardiologist at Children's Hospital of Philadelphia (CHOP). She and co-authors previously published a paper in Circulation
that recognized these defects as being distinct from other types of
"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," she
The study's first author, Jyoti K. Patel was a former cardiac fellow in the Cardiac Center
at CHOP, and conducted the research during her fellowship. The study
team published the research in the September 2016 issue of the Journal of Thoracic and Cardiovascular Surgery
The scientists reported on the use of intraoperative TEE to identify
intramural ventricular septal defects (VSDs). They performed a retrospective study of 337
children, mostly infants, who underwent surgery at CHOP for conotruncal
defects from 2006 to 2013.
The current study was the first to assess the accuracy of TEE in
identifying intramural VSDs. The study team compared intraoperative TEE,
which was performed during surgery, to another imaging tool,
transthoracic echocardiography (TTE), done after surgery.
Of the 337 surgical patients, 34 had intramural VSDs. Of those 34,
both TTE and TEE identified 19 VSDs, while 15 were identified by TTE
only. That data showed that TEE had modest sensitivity (56 percent), but
high specificity (100 percent) in identifying intramural VSDs. 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 reintervention (e.g., further surgery).
"We hope that this research will increase clinicians' awareness of
these intramural defects as an important distinct entity related to
surgical complications," said Patel. "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."