Sedated Echocardiograms Better Characterize Branch Pulmonary Arteries Following Bidirectional Glenn Palliation with Minimal Risk of Adverse Events
- 4 April 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Pediatric Cardiology
- Vol. 41 (5), 955-961
- https://doi.org/10.1007/s00246-020-02342-x
Abstract
Patients post-bidirectional Glenn (BDG) operation are at risk of left and right pulmonary artery (LPA and RPA) hypoplasia. Transthoracic echocardiograms (TTE) in active children can miss essential elements of anatomy. Procedural sedation improves image quality but increases risk of adverse events. We hypothesized that echocardiograms performed with sedation in patients post-BDG would improve visualization of branch pulmonary arteries with minimal adverse events. Patients post-BDG between 2007-2016 were identified. Exclusion criteria were > 12 months of age, absence of complete TTE before discharge, death before discharge, conversion to shunt physiology, and prolonged post-operative course > 7 weeks. Of 254 post-BDG patients, 153 met inclusion/exclusion criteria. TTE reports were reviewed for visualization of LPA/RPA and hypoplasia of LPA/RPA. Blinded assessment of image quality was performed (scale of 1[poor] to 5[excellent]). Pertinent clinical data were recorded. Pearson's chi-squared and Wilcoxon Rank Sum tests used for statistical analysis. The median age at surgery and hospital stay were 4.8 months and 10 days. Twenty-three patients underwent sedated TTE (15%). Sedated TTE significantly improved visualization of the RPA (100% vs 82%, p = 0.029) and LPA, though this did not reach statistical significance (100% vs 91%, p = 0.129). Sedated TTEs has significantly better image quality (median of 4 vs 3, p < 0.001). There were no serious adverse events due to sedation. Sedated TTE early post-BDG is safe, improves visualization of the RPA and LPA, and improves overall image quality. Routine sedated TTE in these patients should be considered. Implications for long-term outcome need to be further analyzed.Funding Information
- National Institutes of Health (UL1 TR002243)
This publication has 22 references indexed in Scilit:
- Implementation of a Quality Improvement Bundle Improves Echocardiographic Imaging after Congenital Heart Surgery in ChildrenJournal of the American Society of Echocardiography, 2016
- Dosing and efficacy of intranasal dexmedetomidine sedation for pediatric transthoracic echocardiography: a retrospective studyCanadian Journal of Anesthesia/Journal canadien d'anesthésie, 2016
- The Impact of Procedural Sedation on Diagnostic Errors in Pediatric EchocardiographyJournal of the American Society of Echocardiography, 2014
- Going beyond Right and Wrong: Building the Framework for Quality Improvement in Congenital Echocardiography—You Can't Manage What You Don't MeasureJournal of the American Society of Echocardiography, 2014
- Diagnostic Errors in Congenital Echocardiography: Importance of Study ConditionsJournal of the American Society of Echocardiography, 2014
- Current outcomes of the Glenn bidirectional cavopulmonary connection for single ventricle palliationEuropean Journal of Cardio-Thoracic Surgery, 2012
- Hypoplastic Left Heart Syndrome: Current Considerations and ExpectationsJournal of the American College of Cardiology, 2012
- Fontan hemodynamics: Importance of pulmonary artery diameterThe Journal of Thoracic and Cardiovascular Surgery, 2009
- Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics supportJournal of Biomedical Informatics, 2008
- Diagnostic Errors in Pediatric EchocardiographyCirculation, 2008