Adherence to physician training guidelines for pediatric transesophageal echocardiography affects the outcome of patients undergoing repair of congenital cardiac defects

Intraoperative echocardiography is widely accepted as being useful during a variety of cardiac surgical procedures. Several applications have been reported during the repair of congenital cardiac defects. National organizations, including the Society of Pediatric Echocardiography and the American Society of Echocardiography, have published guidelines for the provision of at least minimum standards of training and quality for a variety of cardiac ultrasonography procedures. Few data exist concerning whether adherence to such guidelines affects the performance of ultrasonography studies or patient outcome. This study is an outcome-based analysis of intraoperative transesophageal echocardiography performed during repair of congenital cardiac defects during 5-month periods in 2 different years. In year 1, examinations were performed by physicians who met the guidelines for pediatric transesophageal echocardiography published by the American Society of Echocardiography. Those performing examinations in year 2 did not meet those guidelines. Significant differences between the years were found for adequacy of echocardiographic recordings, return to bypass for further surgery based on echocardiographic results, and prevalence and detection of significant residual problems by intraoperative echocardiography. It is concluded that patient outcome is affected beneficially when intraoperative transesophageal echocardiography is performed by physicians who meet the published guidelines, and whose sole responsibility is the performance of echocardiography.