Transesophageal echocardiography probe insertion failure in infants undergoing cardiac surgery

Background: The use of intraoperative transesophageal echocardiography (iTEE) in neonates ≤4kg has not been systematically described. We sought to describe the use of and determine risk factors for iTEE probe insertion failure in small infants. We also sought to develop an algorithm for predicting the likelihood of iTEE probe insertion failure. Design: A retrospective chart review of all neonates ≤4kg who underwent cardiac surgery at our institution from 12/2001 to 12/2006 was performed. Patients who underwent operations that did not typically require TEE were excluded. Risk factors for TEE probe insertion failure were assessed. Results: Of 310 neonates who met the inclusion criteria, 219 (70%) underwent successful iTEE. Lower weight (P <.001), abnormal craniofacial anatomy (P =03), prematurity (P =015), and 22q11 deletion (P =04) were independently associated with iTEE probe insertion failure. Stratified by weight, there was an 80% predicted probability of iTEE probe insertion failure for infants weighing: 2kg with any two of the above risk factors and 3kg with any three of the above risk factors. There was less than an 80% predicted likelihood of iTEE probe insertion failure for infants weighing 4kg regardless of other risk factor status. Conclusions: iTEE can be successfully performed in the majority of neonates ≤4kg undergoing cardiac surgery. However, there are identifiable risk factors for iTEE probe insertion failure. A weight-based algorithm may help determine neonates at risk for iTEE probe insertion failure. Smaller TEE probes may benefit this patient population.