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T ransesophageal echocardiography (TEE) appearsto be a particularly important and helpful imaging tool for intraoperative evaluation of surgical results of con- genital heart disease. *-lo Despite its capability of pro- viding a complete and accurate assessment of many types of reconstructive surgery,single plane TEE hashad significant limitations,2-7 especially for evaluating con- genital heart disease in younger patients. Recently, the availability of miniaturized biplane TEE probes has facilitated thorough investigation of the anatomy and physiology of congenital heart diseases intraoperatively in infants and children.8-10Nonetheless, little specific experiencehas beenreported involving the role of minia- turized high-frequency 7.5 MHz biplane TEE in moni- toring commonly performed repairs such as tetralogy of Fallot (ToF). This study examines the iinpact of intra- operative high-resolution biplane transesophageal echo- cardiographic findings in TOE . . . This study includes 41 patients undergoing 43 surgi- cal repairs of ToF and related lesions between August 1992 and July 1994.Their age at operation ranged from 20 days to 20 years (mean 41 months), with preopera- tive weights ranging from 2.8 to 60 kg (mean 14.6).The following procedures were performed in this series as part of open heart repairs or revisions of prior ToF repair: ventricular septal defect closure in 35 patients, infundibular ‘and right ventricular outflow tract patch in 30 patients, homograft conduit repair in 10 patients, repair of branch peripheral pulmonary artery stenoses in 3 patients, and annuloplasty of tricuspid valve after suc- cessful ToF repair in 1 patient. The echocardiographic systemused in this study was a Hewlett-Packard 1500 system (Andover, Massachu- setts).We used a 7.515.5 MHz biplane probe with 64 X .F rom The Clinical Care Center for Congenital Heart Disease, Ore gon Health Sciences University, 3 18 1 Southwest Sam Jackson Park Road, UHN-60, Portland, Oregon 97201-3098. This study was supported in part by Grant ROl H336472 from the National Heart, Lung, and Blood, Institute, Bethesda, Maryland. Manuscript received Au ust 9, 1995; revised manuscript received October 16, 1995, an 1 accepted October 17. Bntraoperative l’ransesopha Usin r eal Echocardiography R High-Resolution Bip ane 7.5 MHz Probes Wit Continuous-Wave Doppler Capability in lnfants and Children With Tetralogy of Fallot Jinping Xu, MD, Takahiro Shiota, MD, PhD, Shuping Ge, MD, Zheng Gong, MD, Mary J. Rice, MD, Adnan Cobanoglu, MD, and David J. Sahn, MD 64 elements in each plane (9.1 mm maximal introduc- tion diameter on an 8 mm shaft), with color Doppler flow imaging, pulsed-wave Doppler, and continuous- wave (CW) Doppler capability. All transesophageal echocardiographic studies were performed in the oper- ating room. Imaging planes for TEE were obtained as previously described. 6-sAs part of a camp lete study,the following features were specifically evaluated after bypass: (1) residual ventricular septal defect-a ven- tricular septal defect with color flow jet width >3 mm through it was defined as potentially hemodynamically significantx”+ (2) residual right ventricular outflow tract obstruction-residual right ventricular outilow tract obstruction was considered as potentially significant if major anatomic narrowing or turbulent flow with peak velocity >3.0 m/s was determined after bypass.13-l6 Complete preoperative and follow-up postoperative transthoracic echocardiographic studies were also per- formed. The time period between surgery and the latest echocardiographic follow-up study was up to 2 years (mean 6.5 months). Intraoperative TEE was performed without compli- cations and complete studies were obtained in all 41 patients. Imaging resolution was considered by the investigators to be excellent, providing good anatomic detail (Figure 1) compared with our previous experi- ence,8,12 including the ability to image coronary arteries in patients weighing as little as 2.8 kg. Little substantial information was obtained from preoperative trans- esophageal echocardiography when the patient had undergone a complete transthoracic echocardiographic study. In 1 patient, the left anterior descendingcoronary artery was found to course anteriorly across the right ventricular outiow tract, and a transatrial, transpul- monary approach was taken to avoid it during surgery. This had been suspectedon preoperative transthoracic echocardiography but was unequivocal on TEE. In 3 patients, a small but significant atria1 septal defect (diameter ~5 mm), and in 2 other patients, a patent foramen ovale was detectedwith TEE. None was appar- ent on preoperative transthoracic echocardiography.All were confirmed by the surgeon during operation. BRIEF REPORTS 539