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Summary Background Transoesophageal echocardiography (TOE) is feasible in neonates using a miniaturized probe, but is not widely used because of low imaging quality. Aims To assess handling and imaging quality of a new release of a micro-TOE probe in children. Methods Thirty-eight consecutive children, enrolled during February and May 2013, underwent TOE with the Philips S8-3t probe. Insertion, handling and image quality were assessed. Results The 38 children (aged 7 days to 12 years; weight 3.1–27 kg) underwent 75 TOE (30 [40.0%] before cardiac surgery, 31 [41.3%] after cardiac surgery, 4 [5.3%] during a percutaneous procedure, 10 [13.3%] in the intensive care unit). Insertion of the micro-TOE probe was ‘very easy’ in 37/38 patients (97.4%). Handling was better in the lightest children (P = 0.001). Image quality was mainly ‘good’ or ‘very good’, with no significant changes between preoperative and postoperative examinations or over time. Total scores (insertion, handling, image quality) were significantly better in the lightest children (P = 0.02). Preoperative TOE did not provide additional information over transthoracic echocardiography. Postoperative TOE was useful to assess surgical results, but no residual lesions required extracorporeal circulation return. Micro-TOE was useful during the postoperative care of neonatal surgery with open breastbone to assess the surgical result and ventricular function. It was also useful to guide extracorporeal membrane oxygenation (ECMO) indication and withdrawal; and was a useful guide for percutaneous procedures. Conclusion Micro-multiplane TOE is safe and efficient for use in neonates and children. This minimally invasive tool increases the impact of TOE in paediatric cardiology.

The pathophysiology of ventricular septal defect (VSD) is determined by the size of the defect and the state of the pulmonary vascular resistance. We assessed the morphology of VSD using 3D transthoracic echocardiography (3D-TTE) and the ability to estimate the pathophysiology.MethodsForty-eight children with isolated unique muscular (77%) and membranous VSD (23%) were included. Severity of the VSD was rated according to their pathophysiology. (Type 1: minor left-to-right (L-R) shunt; 2a: significant L-R shunt (left ventricular end diastolic diameter (LVEDD) Z-score>2); 2b: VSD associated with pulmonary hypertension). 3D VSD measurements were obtained after a multi-planar reconstruction of a TTE 3D full volume (X5-1 or X7-2 matrix probes, ie33, Philips). Diagnosis properties of the ratio of 3D VSD area to aortic annulus area (3DA/AAA), 3D VSD area to body surface area (3DA/BSA) and 2Dmax diameter to BSA (2DD/BSA) were compared.ResultsMedian age was 8.5 month-old (min 1 max 123). LVEDD Z-score was>2 in 19 children (40%), (12 (25%) had pulmonary hypertension). 3D-VSD systolic area, 3D and 2D max. diameters were correlated with LVEDD. (r=0.71, r=0.52, r=0.55, P0.39 has a sensitivity of 92% and a specificity of 97% to diagnose a 2b-VSD.Conclusion3D-TTE allows a morphological and a quantitative assessment of muscular and membranous VSD. The 3DA/AAA ratio is an accurate diagnostic tool to assess the pathophysiology of the VSD.