A Systematic Approach to Substernal Epicardial Echocardiographic Examination

Objective: The importance of echocardiography in the perioperative management of cardiac surgical patients is widely appreciated. A modified mediastinal drain has been developed, which allows the introduction of a standard TEE probe in a closed-ended sleeve coupled with the drain to permit epicardial echocardiographic imaging after chest closure (substernal epicardial echocardiography [SEE]). The aim of the present study was to develop a standardized and comprehensive SEE examination sequence to allow repeatable examinations with a single movement of the TEE probe inside the drain.Design: Prospective observational protocol.Setting: Tertiary care university hospital.Participants: Ten adult patients undergoing elective cardiac surgery.Interventions: Twenty-three SEE examinations in 10 patients undergoing elective myocardial revascularization to develop a standard examination sequence.Measurements and Main Results: The examination sequence includes 11 views with all the structures relevant for postoperative monitoring. The entire sequence is performed with a single in-out movement of the transesophageal probe to minimize discomfort to patients and the risk of damaging the tube.Conclusions: This new approach to the perioperative monitoring of cardiac surgical patients represents an option for patients in whom TEE is contraindicated or multiple examinations are anticipated because SEE examinations can be performed without the need for sedation in awake patients.