Completion angiogram may be superior to transesophageal echocardiogram for detection of pulmonary artery residual lesions in congenital heart disease surgery

Erick E. Jimenez Granados
Erick E. Jimenez Granados

Erick E. Jimenez Granados; Petros Anagnostopoulos; Catherine C. Allen, MD; Derek B. Hoyme, MD; Luke J. Lamers, MD

Background: Evaluate if completion angiography is more effective than transesophageal echocardiography at detecting of residual pulmonary artery lesions.

 Methods: Retrospective review of 19 surgical cases involving the pulmonary vasculature that had postoperative transesophageal echocardiography and completion angiography from February 2014 to February 2017. Transesophageal echocardiograms were interpreted by two physicians blinded to surgical and completion angiography results. Transesophageal echocardiograms were categorized as adequate repair, inadequate requiring revision or unable to assess. Transesophageal echocardiograms data was compared to results of the completion angiography and to operative notes to determine the ability of each method to detect significant residual lesions.

Results: Mean age 5.4 months and mean weight 5.9 kg. Diagnosis included single ventricle variants (n=14), tetralogy of Fallot variants (n=4) and corrected transposition (n=1). Surgeries included: Glenn operation (n=8), pulmonary artery reconstructions (n=4), main pulmonary artery banding (n=4) and bilateral pulmonary artery banding (n=3). Surgical revision was indicated in 2 of 19 cases by TEE results versus 6 of 19 by completion angiography. Sensitivity of TEE to detect residual lesions of the pulmonary arteries was 40% (95% CI: 12-77%), specificity 100% (95% CI: 78-100%). Positive predictive value was 100% (95% CI: 34-100%) and negative predictive value was 80% (95% CI: 55-93%). Intraoperative angiography related complications included arrhythmia and staining.

Conclusions: Completion angiography may be more effective at detecting post-operative pulmonary artery lesions compared to transesophageal echocardiography. Documentation of pulmonary artery lesions with completion angiography allows immediate surgical revision potentially limiting necessity for future interventions.