Clinical Investigation
Echocardiography in the Very Young
The Miniaturized Multiplane Micro-Transesophageal Echocardiographic Probe: A Comparative Evaluation of Its Accuracy and Image Quality

https://doi.org/10.1016/j.echo.2015.02.013Get rights and content

Background

The initial experience with the miniaturized multiplane micro-transesophageal echocardiographic probe (MTEE) reported high-quality diagnostic imaging in small infants. The aim of this study was to compare the diagnostic accuracy and image quality of the intraoperative MTEE with the pediatric multiplane transesophageal echocardiographic probe (PTEE).

Methods

Infants weighing <5 kg who underwent intraoperative transesophageal echocardiography were identified. Studies using the MTEE were matched 1:1 with those using the PTEE by cardiac diagnosis. The postoperative transesophageal echocardiograms, obtained using either probe, were reviewed for the presence of 11 cardiac abnormalities. Postoperative transesophageal echocardiograms were compared with predischarge transthoracic echocardiograms to assess accuracy. Using receiver operating characteristic curves, the areas under the curve for the MTEE and PTEE were compared. Two pediatric cardiologists scored six image quality metrics on equal numbers of studies obtained with the MTEE and the PTEE. Composite scores from both reviewers were used to compare image quality.

Results

The study included 110 transesophageal echocardiograms per probe type. The mean weight for the MTEE was lower than for the PTEE (3.15 ± 0.58 vs 3.70 ± 0.52 kg, P < .001). There was no significant difference in the diagnostic accuracy of the MTEE and PTEE using receiver operating characteristic curves. The numbers of residual anatomic lesions missed by the MTEE and PTEE were similar (19 vs 22, respectively). The composite image quality score was worse for the MTEE compared with the PTEE (81% vs 92%, respectively, P < .0001).

Conclusions

Although the image quality of the MTEE is inferior compared with the PTEE, its diagnostic accuracy in infants weighing <5 kg is comparable.

Section snippets

Methods

Approval for the study was obtained through the Children’s Healthcare of Atlanta Institutional Review Board. All infants weighing <5 kg who underwent intraoperative TEE at Children’s Healthcare of Atlanta between October 2009 and September 2013 were identified through a review of our institutional electronic echocardiography database. Data collected from the medical records included age and weight at the time of surgery, cardiac diagnosis, type of operation performed, cardiologist performing

Results

The study included 220 transesophageal echocardiograms, 110 each for the MTEE and PTEE. The groups were matched 1:1 for the primary cardiac diagnoses listed in Table 1. MTEE patients weighed less (3.15 ± 0.58 vs 3.70 ± 0.52 kg, P < .001) and were younger in age (24 ± 38 vs 52 ± 58 days, P < .0001) than PTEE patients. There were no reported complications, such as unintentional extubation, esophageal perforation, or significant hemodynamic compromise, with either probe placement or positioning

Discussion

This study shows that the diagnostic accuracy of the MTEE was comparable with that of the PTEE despite a worse quality score for the MTEE. With an increasing number of complex congenital cardiac surgical procedures being performed during early infancy, the need for a miniature probe that could by used for intraoperative assistance with surgery was quite evident. Such patients undoubtedly benefit from accurate transesophageal echocardiographic imaging during cardiac surgery, as missed residual

Conclusions

The quality of images obtained during intraoperative studies performed with the MTEE is inferior compared with images obtained with a PTEE. Despite such differences in quality, however, the MTEE and PTEE are similar in their ability to obtain accurate and clinically diagnostic echocardiographic information. Although our study findings suggest that images obtained with the MTEE are not of equivalent quality to those obtained with a PTEE when both probes could be used in the same patient, we

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