Purpose .– Transoesophageal echocardiography (TEE) impact on post-operative issue is unknown and its application in operating room (OR) and pediatric intensive care unit (PICU) debated.

Aims:

–to describe residual lesions by TEE in the immediate and follow-up post-operative period;

–to determine the feasibility of a new micro-TEE probe dedicated in small infants.

Methods .– One hundred and ninety-six patients were prospectively enrolled. From 2010 to 2012, mini-multi-pediatric TEE (4–7 MHz, tip-length 27 mm, tip-width 10.6 mm) was performed in 176 patients (median weight 15.1 kg [4.5–7]). From 2013, micro-TEE (3–8 MHz, tip-length 18.5 mm, tip-width 7.5 mm) was performed in 20 patients (median weight 11.7 kg, [3.5–40]). Operated lesions were (1) left-to-right shunt, (2) pulmonary obstruction with VSD, (3) left AV valve regurgitation (LAVVR). Residual lesions were assessed by TEE in the OR and by TTE at the last visit (mean follow-up 5 months after surgery). Lesions were classified as severe [residual shunt (RS) > 5 mm, maximal pulmonary gradient (PG) > 50 mmHg, LAVVR grade 4], as moderate (RS 2–5 mm, PG 35–50 mmHg, LAVVR grade 2–3), as mild (RS < 2 mm, PG < 35 mmHg, LAVVR grade < 2). Micro-TEE image quality was scored from 0 to 2.

Results .– One hundred and ten patients (56%) had none residual lesions in the OR. Significant lesions were observed in six patients (3%), all have had a redo surgery (one RS, two PG, three LAVVR). Moderate lesions were observed in 17 patients (9%): one RS (stable), nine PG (one regression, four stable, four aggravated lesions: three awaiting for reoperation and one dilated by balloon), seven stable LAVVR. Mild lesions were observed in 63 patients (32%): 30 RS (24 regression, three stable, three moderate), 16 PG (four regression, four stable, four moderate), 17 LAVVR (six regression, seven stable, four moderate). Image quality of micro-TEE was scored 1 for 2D and 2 for Doppler. In three patients on circulatory assistance, micro-TEE could be performed in PICU with good tolerance and acceptable quality.

Conclusions .– TEE is a tool to evaluate hemodynamic significance of post-operative residual lesions. This new microprobe offers the possibility to perform TEE in small infants in the OR and in unstable patients with poor imaging TTE in PICU.