ABSTRACT 39

SUBSTERNAL EPICARDIAL ECHO: A NEW WINDOW TO THE POSTOPERATIVE HEART

Anthony P. Furnary, Michael A. Savitt,
Robert I. Lowe, J. Timothy Hanlon, David J. Sahn
Oregon Health Sciences University, St. Vincent Medical Center, Providence Heart Institute, Portland, OR, USA

Background: Echocardiographic (ECHO) assessment of the postoperative cardiac surgery patient is often problematic because of poor transthoracic acoustic windows thus necessitating need for transesophageal ECHO for adequate visualization. We hypothesized that a substernally placed ECHO probe (SEE) would give excellent postoperative visualization and enable the possibility of simple beat-to-beat analysis of postoperative ventricular function and size.

Methods: A mediastinal drainage tube was modified with a close-ended sterile “sock” designed to accommodate a non-sterile SEE probe.  The SEE probe was then inserted into the sock so that the ultrasound head of the probe lied in a substernal, epicardial position for postoperative ECHO evaluation.  SEE was compared to TEE after chest closure in 4 dogs and in 13 humans to determine the relative strengths of each modality. 

Results:  SEE images provided excellent structural definition easily comparable to or surpassing those generated by TEE.  Both short and long axis views of all major structures were accessible with closed chest SEE as well as doppler evaluations of all valves.  

Conclusions:  SEE provides easily obtainable, high quality images of the postoperative heart.  This new window to the postoperative heart offers the potential for intraoperative assessment and postoperative monitoring of cardiac function and rapid access and diagnosis in problematic patients.