Application of transesophageal echocardiography in hybrid therapy for neonatal critical pulmonary stenosis

Objective To investigate the clinical application value of transesophageal echocardiography(TEE) in off-pump hybrid therapy of transthoracic balloon pulmonary valvuloplasty for neonatal critical pulmonary stenosis(CPS),and summarize the key points of the operation.Methods Fifteen neonates with CPS underwent hybrid therapy of transthoracic balloon pulmonary valvuloplasty guided by TEE were reanalyzed retrospectively.All patients were performed with a median sternotomy.A purse-string suture was placed in the right ventricular outflow tract 2 cm away from the pulmonary trunk,and then a guide wire and a puncture sheath pipe were inserted.The open situations of pulmonary valves and the transpulmonary valvular gradient pressure were observed by TEE after sequential dilations.Results Fifteen patients for balloon valvuloplasty were all successfully performed with the guidance of TEE,and no severe complications occurred.Both transpulmonary valvular gradient pressure(PTG) and right ventricular systolic pressure decreased significantly compared with those before operation(P ＜0.01).All patients recovered well except for one with residual obstruction followed up at 6 months to 3 years after operation.Conclusions The hybrid therapy without extracorporeal circulation guided by TEE for neonatal CPS is safe and effective,which has the advantages of short operative time,less injury,quicker rehabilitation,etc. Key words: Echocardiography, transesophageal;  Pulmonary valve stenosis;  Infant, newborn;  Hybrid therapy