Unusual form of coarctation of the distal thoracic aorta.

We report the case of a 3-month-old girl with a rare form of coarctation involving the lower descending thoracic aorta. Because of clinical findings of congestive heart failure and hypertension, early repair was recommended. Surgical intervention in young patients with this unusual localization presents a complex challenge. Aortic reconstruction was carried out by patching the stenotic segment with autologous arterial tissue. Three years after the repair, there is no evidence of recoarctation or aneurysmal dilation.

Transesophageal echocardiography with the use of a four-millimeter probe.

Transesophageal echocardiography with the use of pediatric probes is nowadays commonly performed. However, in small children, insertion of a probe with a diameter of 7 mm may be traumatic or even impossible. We therefore tested a 17-element, 4 mm transverse plane probe in 136 pediatric patients, mainly in the operation room, catheterization laboratory, or the intensive care unit, and in three healthy adult volunteers. This probe was easy to insert, particularly during emergency situations, did not cause any complication in any patient, and provided satisfactory information despite the low number of elements. The use of a 4 mm transesophageal probe can improve the management of neonates with congenital heart disease in the operating room or the neonatal intensive care unit.

Usefulness of biplane transesophageal echocardiography in neonates, infants and children with congenital heart disease.

A study was performed to assess the feasibility, additional diagnostic value and potential applications of biplane transesophageal echocardiography in neonates, infants and children. One hundred thirty-two consecutive studies were attempted in 111 anesthetized children with congenital heart disease. Longitudinal and transverse planes were compared using 3 methods: (1) separate 7 mm longitudinal and transverse pediatric transducers used sequentially; (2) an experimental 9 x 8 mm biplane pediatric transducer; and (3) a standard adult biplane transducer (12 x 9 or 13 x 9 mm). In all but 1 patient, a probe could be inserted. The longitudinal plane provided superior visualization of both the right and left ventricular outflow tracts, the interatrial septum, the main pulmonary artery, the ascending aorta and the right coronary artery. In 18 patients (16%), the longitudinal plane provided completely new diagnostic information that was not obtained with combined transthoracic and transverse plane transesophageal echocardiography. However, the transverse plane was mandatory for demonstration of the 4-chamber view, short-axis cross sections through the great arteries, the distal right pulmonary artery and bifurcation of the left coronary artery. The longitudinal plane is complementary to the transverse plane, but cannot substitute for it.

Total anomalous pulmonary venous connection.

Repair of total anomalous pulmonary venous connection was performed on 31 patients aged 12 days to 14 years (18 less than 6 months). The connection type was supracardiac in 20 cases, cardiac in nine, infracardiac in one case and mixed in one. Deep hypothermia and circulatory arrest were used in 23 cases (74%). In supracardiac type cases the atrial septal defect was closed through the left atriotomy, without enlargement of the left atrium. Extubation in the operating room was possible in 26 cases (84%). Three patients (9.6%) died, one (with connection to the coronary sinus) soon after operation, due to a management error, another (with connection to the right superior vena cava) of pulmonary edema, and an infant with mixed-type connection 1 week postoperatively, presumably from an arrhythmia. No patient required reoperation because of late pulmonary venous stenosis. There were no late deaths. The technique of elevating the cardiac apex provided excellent exposure in the supracardiac and infracardiac types. Progressively earlier referral during the study period facilitated prompt operation and improved patient salvage.

Transesophageal echocardiography in pediatric patients: preliminary results.

Transesophageal echocardiography was attempted in 59 pediatric patients with congenital heart disease in the operating room (n = 33) or during heart catheterization or in the intensive care unit (n = 26). Six different commercially available transducers were used with diameters ranging from 7 to 15 mm. Age ranged from 1 day to 16 years, and body weight ranged from 3.7 to 65 kg. Objectives of the study were to determine (1) minimum body weight in which transesophageal echocardiography with various probes is possible, (2) additional diagnostic value, and (3) potential applications. In three cases (one surgical and two nonsurgical) the probe could not be inserted. Minimum body weight was 17 to 20 kg for probes with a diameter of greater than or equal to 13 mm and approximately 12 kg for the 11 mm probes. A 7 mm probe, on the other hand, could be inserted easily in all patients (including a neonate) in whom transesophageal echocardiography was attempted. In 11 of 56 patients, additional diagnostic information was obtained. Thus, transesophageal echocardiography is feasible in the pediatric age group provided that special probes are used in small children. Additional diagnostic information can be obtained, and the technique is of value during cardiac surgery or balloon interventions for evaluation of the efficacy of the procedure and for monitoring ventricular function.