There are four types of echocardiograms that can be used as diagnostic or pre- and post-surgery quality control tools for children with Congenital Heart Disease (CHD). All are painless to the patient and provide detailed looks at the heart and its functioning.
The most common type of echocardiogram is a transthoracic echo (TTE). In a TTE, sound waves are sent through a handheld device placed on a child’s chest to show the structure and function of the heart on a monitor. A TTE requires that patients lie quietly on their sides for up to 40 minutes, depending on the complexity of the diagnosis. There is no pain involved, but small children may be afraid or unable to lie still for that long. While distraction techniques usually work well, children may need light sedation to allow the sonographer to capture the best pictures.
“Patients are sent to us for a TTE before heart surgery to review all segments of the heart and its vessels,” said William Border, MD, Director of Noninvasive Cardiac Imaging at Children’s Heart Center. “Often there’s more than one issue going on in the heart, and we must capture every little detail to help surgeons determine what type of surgery is needed and when to do it.”
Transesophageal echocardiography (TEE) is a similar test that produces pictures of the heart, but unlike the standard echocardiogram, the echo transducer is attached to a thin tube – about the size of a baby finger – that passes through the patient’s mouth, down the throat and into the esophagus. Because the esophagus is so close to the chambers of the heart, very clear images of those heart structures and valves can be obtained by TEE. TEE is also used if the TTE was non-diagnostic, which is sometimes the case in adult-sized patients. Doctors also use TEE in conjunction with heart surgery.
TEE is used to evaluate the heart just before the surgeon makes the first incision,” Dr. Border said. “In addition, when the patient comes off bypass after surgery, we can evaluate the repair using TEE before closure of the chest. If there is any problem with the repair, the patient goes back on bypass and the surgeon can fix the problem. We can also use TEE to determine the proper placement of an ASD device in the cardiac cath lab.”
Fetal echoes provide detailed assessments of the fetal heart. Getting a correct diagnosis before the baby is born allows for conversations with the family about the diagnosis and proper planning for delivery and possible subsequent surgeries after birth. Parents can get a tour of the cardiology unit, receive in depth education and information about their baby’s condition and meet with their heart surgeon – all before their baby is even born.
A stress echo provides echo images before, during and after exercise to give doctors information about how the patient’s heart performs under the stress of exercise. Doctors can track an obstruction during exercise, determine whether the patient needs to adhere to restrictions or whether there is a need for medication.
Dr. Border suggests that parents discuss what’s going to happen ahead of the echo procedure with their young children if they are old enough to understand. Preparing them to lie still for an extended period of time and bringing along any distraction items that work well for their child will ensure that the sonographer is able to obtain the best pictures.
Click here to access an echo fact sheet.
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