BY RICHARD MARK KIRKNER
Frontline Medical News
FROM THE JOURNAL OF THORACIC AND
Intramural ventricular septal defects (VSD), residual defects that can occur after repair of conotruncal defects in newborns, increase the risk of complica- tions and death if they’re not detected and closed
during the index operation.
While various methods have been tried to find these
defects during surgery, researchers from Children’s
Hospital of Philadelphia (CHOP) reported that the
use of transesophageal echocardiography (TEE) has
a good chance of finding VSDs and giving cardiac
surgeons the opportunity to correct these residual
“TEE has modest sensitivity but high specificity for
identifying intramural VSDs and can identify most defects requiring reinterventions,” Jyoti Patel, MD, and her
coauthors reported in a study published in the September issue of the Journal of Thoracic and Cardiovascular
Previous studies have shown that intraoperative TEE
is safe for evaluating operations in congenital heart
disease, but this is the first study to evaluate the modality for detecting intramural VSDs, Dr. Patel and her
Dr. Patel and her coinvestigators analyzed the results
of TEE and postoperative transthoracic echocardiog-
raphy (TTE) in patients who had biventricular repair of
conotruncal anomalies at CHOP over the period from
January 2006 through June 2013.
Intramural VSDs occurred in 34 of the 337 patients
who met the inclusion criteria for the study out of a total population of 903.
Actually, 462 patients had biventricular repairs of
conotruncal defects involving baffle closure of a VSD,
but 125 were excluded for various reasons, including
105 for inadequate intraoperative TEE.
TTE identified a total of 177 residual VSDs, 34 of
which were intramural in nature.
Among the evaluated procedures, both TEE at the
end of the index operation and TTE detected VSD in 19
patients; TTE alone found VSD in 15.
“Sensitivity was 56% and specificity was 100% for
Intramural VSD by TTE (Top) and TEE
(Bottom). Two-dimensional (left) and color
(right) images of a VSD patch (arrow) that
connects the ventricular septum to the RV wall
instead of the base of the aortic valve (Ao).
Can TEE find
TEE showed modest sensitivity but
high specificity in finding VSDs
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